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Gao Y, Chen S, Fu J, Wang C, Tang Y, Luo Y, Zhuo X, Chen X, Shen Y. Factors associated with risk analysis for asymptomatic left ventricular diastolic dysfunction in nondialysis patients with chronic kidney disease. Ren Fail 2024; 46:2353334. [PMID: 38785296 PMCID: PMC11133225 DOI: 10.1080/0886022x.2024.2353334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Heart failure (HF) constitutes a major determinant of outcome in chronic kidney disease (CKD) patients. The main pattern of HF in CKD patients is preserved ejection fraction (HFpEF), and left ventricular diastolic dysfunction (LVDD) is a frequent pathophysiological mechanism and specific preclinical manifestation of HFpEF. Therefore, exploring and intervention of the factors associated with risk for LVDD is of great importance in reducing the morbidity and mortality of cardiovascular disease (CVD) complications in CKD patients. We designed this retrospective cross-sectional study to collect clinical and echocardiographic data from 339 nondialysis CKD patients without obvious symptoms of HF to analyze the proportion of asymptomatic left ventricular diastolic dysfunction (ALVDD) and its related factors associated with risk by multivariate logistic regression analysis. Among the 339 nondialysis CKD patients, 92.04% had ALVDD. With the progression of CKD stage, the proportion of ALVDD gradually increased. The multivariate logistic regression analysis revealed that increased age (OR 1.237; 95% confidence interval (CI) 1.108-1.381, per year), diabetic nephropathy (DN) and hypertensive nephropathy (HTN) (OR 25.000; 95% CI 1.355-48.645, DN and HTN vs chronic interstitial nephritis), progression of CKD stage (OR 2.785; 95% CI 1.228-6.315, per stage), increased mean arterial pressure (OR 1.154; 95% CI 1.051-1.268, per mmHg), increased urinary protein (OR 2.825; 95% CI 1.484-5.405, per g/24 h), and low blood calcium (OR 0.072; 95% CI 0.006-0.859, per mmol/L) were factors associated with risk for ALVDD in nondialysis CKD patients after adjusting for other confounding factors. Therefore, dynamic monitoring of these factors associated with risk, timely diagnosis and treatment of ALVDD can delay the progression to symptomatic HF, which is of great importance for reducing CVD mortality, and improving the prognosis and quality of life in CKD patients.
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Affiliation(s)
- Yajuan Gao
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shengnan Chen
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jiani Fu
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Cui Wang
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yali Tang
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yongbai Luo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiaozhen Zhuo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xueying Chen
- Department of Nephrology, Shan Yang County People’s Hospital, Shangluo City, China
| | - Yan Shen
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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2
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Subbotina A, Skjølsvik E, Solbu MD, Miroslawska A, Steigen T. Echocardiographic findings following renal sympathetic denervation for treatment resistant hypertension, the ReShape CV-risk study. Blood Press 2024; 33:2326298. [PMID: 38469724 DOI: 10.1080/08037051.2024.2326298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The aim of this study was to describe and compare echocardiographic findings before renal sympathetic denervation (RDN) and 6 and 24 months after the procedure. MATERIALS AND METHODS Patients with treatment resistant hypertension (TRH) were included in this non-randomised intervention study. RDN was performed by a single experienced operator using the Symplicity Catheter System. Echocardiographic measurements were performed at baseline, and after 6 and 24 months. RESULTS The cohort consisted of 21 patients with TRH, with a mean systolic office blood pressure (BP) of 163 mmHg and mean diastolic BP 109 mmHg. Mixed model analysis showed no significant change in left ventricular (LV) mass index (LVMI) or left atrium volume index (LAVI) after the RDN procedure. Higher LVMI at baseline was significantly associated with greater reduction in LVMI (p < 0.001). Relative wall thickness (RWT) increased over time (0.48 mm after two years) regardless of change in BP. There was a small but significant reduction in LV end-diastolic (LVIDd) and end-systolic (LVIDs) diameters after RDN, with a mean reduction of 2.6 and 2.4 mm, respectively, after two years. Progression to concentric hypertrophy was observed only in in patients who did not achieve normal BP values, despite BP reduction after RDN. CONCLUSION There was no reduction of LV mass after RDN. We found a small statistically significant reduction in LVIDd and LVIDs, which together with increase in RWT can indicate progression towards concentric hypertrophy. BP reduction after RDN on its own does not reverse concentric remodelling if target BP is not achieved.
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Affiliation(s)
- Anna Subbotina
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eystein Skjølsvik
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Dahl Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Atena Miroslawska
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Terje Steigen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
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Hua L, Zhang R, Chen R, Shao W. A nomogram for predicting the risk of heart failure with preserved ejection fraction. Int J Cardiol 2024; 407:131973. [PMID: 38508321 DOI: 10.1016/j.ijcard.2024.131973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND This study purposed to design and establish a nomogram to predict the risk of having heart failure with preserved ejection fraction. METHOD The clinical data of 1031 patients diagnosed with heart failure (HF) in the First Affiliated Hospital of Jinan University from January 2018 to December 2022 were retrospectively analyzed, among which 618 patients were diagnosed with heart failure with preserved ejection fraction (HFpEF). Patients were randomly divided into a training set (70%, n = 722) and a validation set (30%, n = 309). The prediction model of HFpEF was established by using clinical characteristic data parameters, and the risk of having HFpEF was predicted by using a nomogram. Single-factor analysis was used to select independent risk factors (P < 0.05), and then binary logistic regression was used to screen predictive variables (P < 0.05). The discrimination ability of the model was evaluated by the ROC curve and calculating the area under the curve (AUC). In addition, the predictive ability of the established nomogram was evaluated using calibration curves and the Hosmer-Lemeshow goodness of fit test (HL test), and the clinical net benefit was evaluated using decision curve analysis (DCA). RESULTS The results of binary logistic regression analysis showed that age, gender, hypertension, coronary heart disease, glycosylated hemoglobin, serum creatinine, E/e' septal, relative wall thickness (RWT), left ventricular mass index (LVMI) and pulmonary hypertension (PH) were independent influencing factors for the risk of having HFpEF (P < 0.05). Based on the results of logistic regression analysis, a nomogram was established and calibration curves were made. The prediction model showed that the AUC of the training dataset was 0.876 (95%CI, 0.851-0.902), and 0.837 (95%CI, 0.791-0.883) in the validation set. According to the calibration curves and HL test, the nomogram shows good calibration, and DCA shows that our model is clinically useful. CONCLUSION A nomogram prediction model was constructed to predict the patient's risk of having HFpEF. This prediction model indicated that the combination of creatinine, E/e', RWT, LVMI and PH may be valuable in the diagnosis of HFpEF.
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Affiliation(s)
- Li Hua
- Department of Emergency, First Affiliated Hospital of Jinan University, West Huangpu Avenue 613, Tianhe District, Guangzhou, Guangdong Province 510630, China.
| | - Rong Zhang
- Department of Emergency, First Affiliated Hospital of Jinan University, West Huangpu Avenue 613, Tianhe District, Guangzhou, Guangdong Province 510630, China
| | - Ruichang Chen
- Department of Emergency, First Affiliated Hospital of Jinan University, West Huangpu Avenue 613, Tianhe District, Guangzhou, Guangdong Province 510630, China
| | - Wenming Shao
- Department of Emergency, First Affiliated Hospital of Jinan University, West Huangpu Avenue 613, Tianhe District, Guangzhou, Guangdong Province 510630, China
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Ye R, Zhang X, Zhang Z, Wang S, Liu L, Jia S, Yang X, Liu X, Chen X. Association of cardiometabolic and triglyceride-glucose index with left ventricular diastolic function in asymptomatic individuals. Nutr Metab Cardiovasc Dis 2024; 34:1590-1600. [PMID: 38499451 DOI: 10.1016/j.numecd.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND AND AIMS Obesity and insulin resistance are associated with left ventricular diastolic dysfunction (LVDD) and increased risk of heart failure. Cardiometabolic index (CMI) and triglyceride glucose (TyG) are new indexes to assess visceral obesity and insulin resistance, respectively. The study aimed to investigate the clinical usefulness of these indexes for identifying LVDD individuals. METHODS AND RESULTS Overall, 1898 asymptomatic individuals were included in this cross-sectional study. Participants underwent anthropometrics, serum biochemical evaluation, and echocardiography. Multiple linear regression analysis revealed that both indexes were independent determinants of diastolic parameters among females; while for males, CMI and TyG were not associated with A velocity. In the multivariate logistic analysis, the proportion of LVDD in the third and fourth quartiles of CMI remained significantly greater than that in the lowest quartile in females (Q3 vs. Q1: odds ratio (OR) = 2.032, 95% confidence interval (CI): 1.181-3.496; Q4 vs. Q1: OR = 2.393, 95% CI: 1.347-4.249); while in males, the incidence of LVDD was significantly greater only in the fourth quartile. For TyG, the presence of LVDD in the fourth quartile was significantly greater in both genders. The discriminant values between the CMI (AUC: 0.704, 95% CI: 0.668-0.739) and TyG (AUC: 0.717, 95% CI: 0.682-0.752) were similar in females. Both indexes performed better in females than in males to identify LVDD. CONCLUSION The CMI and TyG might both serve as effective tools to identify LVDD in routine health check-ups in primary care, mainly in females. With simpler parameters, the CMI could be utilized in medically resource-limited areas.
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MESH Headings
- Humans
- Female
- Male
- Cross-Sectional Studies
- Triglycerides/blood
- Ventricular Function, Left
- Middle Aged
- Blood Glucose/metabolism
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/diagnostic imaging
- Diastole
- Biomarkers/blood
- Adult
- Asymptomatic Diseases
- Insulin Resistance
- Risk Assessment
- Cardiometabolic Risk Factors
- Predictive Value of Tests
- Obesity, Abdominal/diagnosis
- Obesity, Abdominal/epidemiology
- Obesity, Abdominal/physiopathology
- Obesity, Abdominal/blood
- Sex Factors
- Incidence
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Affiliation(s)
- Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhipeng Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Si Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lu Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shanshan Jia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangyu Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xueting Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Chan JC, Menon AP, Rotta AT, Choo JTL, Hornik CP, Lee JH. Use of Speckle-Tracking Echocardiography in Septic Cardiomyopathy in Critically Ill Children: A Narrative Review. Crit Care Explor 2024; 6:e1114. [PMID: 38916605 DOI: 10.1097/cce.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVES In critically ill children with severe sepsis, septic cardiomyopathy (SCM) denotes the subset of patients who have myocardial dysfunction with poor response to fluid and inotropic support, and higher mortality risk. The objective of this review was to evaluate the role of speckle-tracking echocardiography (STE) in the diagnosis and prognosis of pediatric SCM in the PICU setting. DATA SOURCES We performed detailed searches using PubMed, Scopus, Web of Science, and Google Scholar. Reference lists of all included studies were also examined for further identification of potentially relevant studies. STUDY SELECTION Studies with the following medical subject headings and keywords were selected: speckle-tracking echocardiography, strain imaging, global longitudinal strain, echocardiography, sepsis, severe sepsis, septic shock, septic cardiomyopathy, and myocardial dysfunction. DATA EXTRACTION The following data were extracted from all included studies: demographics, diagnoses, echocardiographic parameters, severity of illness, PICU management, and outcomes. DATA SYNTHESIS STE is a relatively new echocardiographic technique that directly quantifies myocardial contractility. It has high sensitivity in diagnosing SCM, correlates well with illness severity, and has good prognosticating value as compared with conventional echocardiographic parameters. Further studies are required to establish its role in evaluating biventricular systolic and diastolic dysfunction, and to investigate whether it has a role in individualizing treatment and improving treatment outcomes in this group of patients. CONCLUSIONS STE is a useful adjunct to conventional measures of cardiac function on 2D-echocardiography in the assessment of pediatric SCM in the PICU.
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Affiliation(s)
- J Charmaine Chan
- Pediatric Cardiology, KK Women's and Children's Hospital, Singapore
- Singhealth Duke NUS Pediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Anuradha P Menon
- Singhealth Duke NUS Pediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Children's ICU, KK Women's and Children's Hospital, Singapore
| | - Alexandre T Rotta
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, NC
| | - Jonathan T L Choo
- Pediatric Cardiology, KK Women's and Children's Hospital, Singapore
- Singhealth Duke NUS Pediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Christoph P Hornik
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Jan Hau Lee
- Singhealth Duke NUS Pediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Children's ICU, KK Women's and Children's Hospital, Singapore
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O'Driscoll JM, McCarthy FP, Giorgione V, Jalaludeen N, Seed PT, Gill C, Sparkes J, Poston L, Marber M, Shennan AH, Chappell LC, Thilaganathan B, Leeson P. Left Atrial Mechanics Following Preeclamptic Pregnancy. Hypertension 2024; 81:1644-1654. [PMID: 38757271 DOI: 10.1161/hypertensionaha.123.22577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/05/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Preterm preeclampsia is a pregnancy complication associated with myocardial dysfunction and premature cardiovascular disease morbidity and mortality. Left atrial (LA) strain is a noninvasive index of left ventricular end diastolic pressure and an early marker of heart failure risk. This study aimed to evaluate LA strain during the postpartum period in participants with and without preterm preeclampsia and to assess whether this varied in the presence of hypertension, cardiac dysfunction or both. METHODS In this longitudinal cohort study, 321 women from 28 hospitals with preterm preeclampsia (cases) underwent cardiovascular assessment 6 months postpartum. This is a secondary analysis of the PHOEBE study (ISRCTN01879376). An uncomplicated pregnancy control group (n=30) was recruited from a single center for comparison. A full cross-sectional transthoracic echocardiogram was performed, and from these images, the myocardial strain of the left atrium, including reservoir, conduit, and contractile strain, as well as LA stiffness, were calculated. RESULTS At 6 months postpartum, compared with controls, prior preeclampsia was associated with a significantly attenuated LA reservoir, conduit, and contractile strain, as well as increased LA stiffness (all P<0.001). LA strain was further reduced in preeclamptic women who had and had not developed hypertension, systolic, or diastolic dysfunction at 6 months postpartum (all P<0.05). CONCLUSIONS LA mechanics were significantly attenuated at 6 months postpartum in participants with preterm preeclampsia, whether or not they remained hypertensive or had evidence of ventricular dysfunction. Further studies are needed to determine whether postnatal LA strain may identify women at greater risk for future cardiovascular disease.
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Affiliation(s)
- Jamie M O'Driscoll
- School of Psychology and Life Science, Canterbury Christ Church University, Kent, United Kingdom (J.M.O.D.)
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (J.M.O.D.)
| | - Fergus P McCarthy
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
- Department of Obstetrics and Gynaecology, The INFANT Research Centre, University College Cork, Cork University Maternity Hospital, Ireland (F.P.M.C.)
| | - Veronica Giorgione
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's University of London, United Kingdom (V.G., B.T.)
| | - Navazh Jalaludeen
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom (N.J.)
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Carolyn Gill
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Jenie Sparkes
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Mike Marber
- Cardiovascular Division, King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus, United Kingdom (M.M.)
| | - Andrew H Shennan
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's University of London, United Kingdom (V.G., B.T.)
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, University of Oxford, United Kingdom (P.L.)
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Magodoro IM, Guerrero-Chalela CE, Claggett B, Jermy S, Samuels P, Myer L, Zar HJ, Jao J, Ntsekhe M, Siedner MJ, Ntusi NAB. Cardioprotective effects of early versus late initiated antiretroviral treatment in adolescents with perinatal HIV-1 infection. Sci Rep 2024; 14:14234. [PMID: 38902326 PMCID: PMC11189904 DOI: 10.1038/s41598-024-65119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
Whether, and how, cardioprotective effects of antiretroviral treatment (ART) in adolescents with perinatal HIV infection (APHIV) vary with age at treatment initiation is unknown. We used magnetic resonance imaging to compare cardiac status between APHIV initiated on ART at < 5 years of age (early ART, n = 37) and ≥ 5 years of age (delayed ART, n = 34) versus HIV-uninfected peers (n = 21), reporting z-score mean differences adjusted for confounders. Relative to HIV-uninfected adolescents, APHIV with early ART had higher left ventricular (LV) global circumferential strain (GCS) [adjusted mean (95%CI) z-score: 0.53 (0.13, 0.92)] and maximum indexed left atrium volume (LAVi) [adjusted z-score: 0.55 (0.08, 1.02)]. In contrast, APHIV with delayed ART had greater indexed LV end-diastolic volume (LVEDVi) [adjusted z-score: 0.47 (0.09, 0.86)] and extracellular volume fraction [adjusted z-score: 0.79 (0.20, 1.37)], but lower GCS [adjusted z-score: -0.51 (-0.91, -0.10)] than HIV-uninfected peers. APHIV had distinct albeit subclinical cardiac phenotypes depending on ART initiation age. Changes in early ART suggested comparatively worse diastology with preserved systolic function while delayed ART was associated with comparatively increased diffuse fibrosis and LV dilatation with reduced systolic function. The long-term clinical significance of these changes remains to be determined.
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Affiliation(s)
- Itai M Magodoro
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, J46, Old Main Building, Main Road, Observatory, Cape Town, 7925, South Africa.
| | | | - Brian Claggett
- Cardiology Division, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen Jermy
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Petronella Samuels
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- SA-MRC Unit on Child and Adolescent Health, Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Jennifer Jao
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Adult Infectious Diseases, Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mpiko Ntsekhe
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, J46, Old Main Building, Main Road, Observatory, Cape Town, 7925, South Africa
| | - Mark J Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Ntobeko A B Ntusi
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, J46, Old Main Building, Main Road, Observatory, Cape Town, 7925, South Africa.
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa.
- South African Medical Research Council Extramural Unit on Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa.
- ARUA/Guild Cluster of Research Excellence on Noncommunicable Diseases and Associated Multimorbidity, CAPETOWN, South Africa.
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Bonello B, Issitt R, Hughes M, Carr M, Iriart X, Khambadkone S, Giardini A, Kostolny M, Marek J. Long-term outcome after neonatal intervention for congenital critical aortic stenosis. Int J Cardiol 2024; 405:131932. [PMID: 38437954 DOI: 10.1016/j.ijcard.2024.131932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/08/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND This study explored long-term outcome and functional status of patients born with critical aortic stenosis (CAS) following neonatal surgical or catheter interventions. METHODS A 40-year retrospective review of all consecutive patients within a large, single-center referral unit who required neonatal (<30 days) intervention for CAS. Additional detailed evaluation of surviving patients >7 years age was performed, with clinical assessment, objective cardiopulmonary exercise testing and state-of-the-art characterization of myocardial function (advanced echocardiography and cardiac MRI). RESULTS Between 1970 and 2010, ninety-six neonates underwent CAS intervention (mean age 9 ± 7.5 days). Early death occurred in 19 (19.8%) and late death in 10 patients. Overall survival at 10 and 30 years was 70.1% and 68.5%, freedom from reintervention was 41.8% and 32.9% respectively. Among the 25 long-term survivors available for detailed assessment (median age 15.7 ± 6.4 years), 55% exhibited impaired peak oxygen uptake. Mean left ventricle (LV) ejection fraction was 65 ± 11.2%, with a mean LV end-diastolic volume z-score of 0.02 ± 1.4. Mean LV outflow tract Vmax was 2.3 ± 1.02 m/s. CAS patients had reduced LV longitudinal and increased radial strain (p = 0.003, p < 0.001 respectively). Five patients had severe LV diastolic dysfunction associated with endocardial fibroelastosis (EFE) (p = 0.0014). CONCLUSION Despite high early mortality rate, long-term survival of patients with CAS is reasonable at the expense of high reintervention rate. With successful intervention, there remained long-term clinical and subclinical LV myocardial impairment, of which EFE was one marker. Long-term follow-up of all CAS patients is crucial, involving detailed myocardial functional assessment to help elucidate physiology and optimise management.
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Affiliation(s)
- Beatrice Bonello
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Richard Issitt
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Marina Hughes
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich NR4 7UY, UK.
| | - Michelle Carr
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
| | - Xavier Iriart
- CHU Bordeaux, Av. du Haut Lévêque, Pessac 33604, France.
| | - Sachin Khambadkone
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | | | - Martin Kostolny
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Jan Marek
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; University College of London, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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Bai M, Chen D, Liu Y, Ran X, Wang C, Chen L, Yan D, He S, Wu M, Luo B, Wang W, Lei Z, Gao Y. Cardiac electrophysiology, structure and diastolic function in patients with diabetic foot versus those without diabetic foot. J Diabetes Investig 2024. [PMID: 38860568 DOI: 10.1111/jdi.14250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 05/10/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
AIMS/INTRODUCTION To evaluate the differences in cardiac autonomic function, cardiac structure and diastolic function between individuals with diabetic foot (DF) and those with diabetes but without DF. MATERIALS AND METHODS A total of 413 individuals with DF and 437 without DF who underwent a 24-h electrocardiogram Holter and a Doppler echocardiogram were included. The heart rate variability parameters to evaluate cardiac autonomic function, and the indices for the assessment of cardiac structure and left ventricular (LV) diastolic function, including left atrium, LV posterior wall thickness, interventricular septum and E/e' ratio, were measured or calculated. Propensity score matching was used for the sensitivity analysis to minimize potential imbalance. RESULTS In both the crude and propensity score matching analyses, significant differences were observed in heart rate variability between individuals with and without DF, as evidenced by lower standard deviation of the normal sinus interval, lower low-frequency power/high-frequency power ratio, lower standard deviation of the 5-min average RR intervals, lower low-frequency power, lower percentage of normal adjacent RR interval difference >50 ms, lower root mean square of successive RR interval differences and lower high-frequency power (all P < 0.05). In multivariate analysis, DF showed an independent negative correlation with the aforementioned indices of heart rate variability (all P < 0.05). Individuals with DF showed higher left atrium, LV posterior wall thickness, interventricular septum and a higher E/e' ratio than those without DF in the crude analysis (all P < 0.05), whereas these indices were no longer associated with DF in the multivariate analysis and the propensity score matching analyses. CONCLUSIONS Cardiac autonomic modulation was more severely impaired in individuals with DF than in their counterparts without DF. There has been insufficient evidence to demonstrate the independent association of DF and LV diastolic dysfunction.
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Affiliation(s)
- Mingxin Bai
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dawei Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Liu
- Department of Endocrinology, Chengdu Eighth People's Hospital, Chengdu, Sichuan, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chun Wang
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihong Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Donge Yan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Murong Wu
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Luo
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wen Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyi Lei
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yun Gao
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Tao H, Shen X, Zou L, Zhang C, Hong L. Left atrial volume index and interleukin-6 as predictors for postoperative atrial fibrillation. J Cardiothorac Surg 2024; 19:325. [PMID: 38849891 PMCID: PMC11157838 DOI: 10.1186/s13019-024-02813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/25/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. However, the predictive value of single indictor still remains controversial. This study aimed to assess the predictive value of combining preoperative left atrial volume index (LAVI) and postoperative interleukin-6 (IL-6) for POAF in the patients receiving cardiac surgery. METHODS Patients who admitted to Nanjing First Hospital during the study period between December 2022 and June 2023, and underwent open-heart surgery without a history of atrial fibrillation (AF) were enrolled. The relationships between predictors and POAF were investigated using logistic regression analysis. We determined the combined predictive value of LAVI and IL-6 for POAF by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvements (NRIs) and integrated discrimination improvement (IDIs). RESULTS 102 patients were enrolled in this study, and 50 participants developed POAF (49.0%). Patients who experienced POAF had higher levels of preoperative LAVI and postoperative IL-6 than those who did not. Regression analysis revealed that larger LAVI and higher level of IL-6 were independently associated with increased risk of POAF. The combined addition of LAVI and IL-6 to the predictive model resulted in an evident increase in the AUC. Incorporating both LAVI and IL-6 increased IDIs in all models. CONCLUSION Our results demonstrated that combined LAVI and IL-6 achieved a higher prediction performance for POAF.
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Affiliation(s)
- Hong Tao
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu Province, 210006, China
| | - Xiao Shen
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu Province, 210006, China
| | - Lei Zou
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu Province, 210006, China
| | - Cui Zhang
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu Province, 210006, China.
| | - Liang Hong
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu Province, 210006, China.
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11
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Zhou Q, Wang L, Craft J, Weber J, Passick M, Ngai N, Khalique OK, Goldfarb JW, Barasch E, Cao JJ. A machine learning-derived risk score to predict left ventricular diastolic dysfunction from clinical cardiovascular magnetic resonance imaging. Front Cardiovasc Med 2024; 11:1382418. [PMID: 38903970 PMCID: PMC11187483 DOI: 10.3389/fcvm.2024.1382418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction The evaluation of left ventricular diastolic dysfunction (LVDD) by clinical cardiac magnetic resonance (CMR) remains a challenge. We aimed to train and evaluate a machine-learning (ML) algorithm for the assessment of LVDD by clinical CMR variables and to investigate its prognostic value for predicting hospitalized heart failure and all-cause mortality. Methods LVDD was characterized by echocardiography following the ASE guidelines. Eight demographic and nineteen common clinical CMR variables including delayed enhancement were used to train Random Forest models with a Bayesian optimizer. The model was evaluated using bootstrap and five-fold cross-validation. Area under the ROC curve (AUC) was utilized to evaluate the model performance. An ML risk score was used to stratify the risk of heart failure hospitalization and all-cause mortality. Results A total of 606 consecutive patients underwent CMR and echocardiography within 7 days for cardiovascular disease evaluation. LVDD was present in 303 subjects by echocardiography. The performance of the ML algorithm was good using the CMR variables alone with an AUC of 0.868 (95% CI: 0.811-0.917), which was improved by combining with demographic data yielding an AUC 0.895 (95% CI: 0.845-0.939). The algorithm performed well in an independent validation cohort with AUC 0.810 (0.731-0.874). Subjects with higher ML scores (>0.4121) were associated with increased adjusted hazard ratio for a composite outcome than subjects with lower ML scores (1.72, 95% confidence interval 1.09-2.71). Discussion An ML algorithm using variables derived from clinical CMR is effective in identifying patients with LVDD and providing prognostication for adverse clinical outcomes.
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Affiliation(s)
- Qingtao Zhou
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Lin Wang
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Jason Craft
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Jonathan Weber
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Michael Passick
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Nora Ngai
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Omar K. Khalique
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - James W. Goldfarb
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Eddy Barasch
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - J. Jane Cao
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
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Masrouri S, Tamehri Zadeh SS, Afaghi S, Hadaegh F, Khalili D, Shapiro MD. Association of Anthropometric Indices With Midlife Cardiovascular Risk in Young Individuals Without Obesity and Traditional Risk Factors. J Am Heart Assoc 2024:e033355. [PMID: 38842274 DOI: 10.1161/jaha.123.033355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The aim of this study was to assess how early-adulthood body mass index (BMI) and waist circumference (WC) relate to long-term cardiovascular structure, function, and prognosis in individuals without obesity and with low cardiovascular risk factor (CVRF) burden. METHODS AND RESULTS A total of 2024 participants aged 18 to 30 from the CARDIA (Coronary Artery Risk Development in Young Adults) study, without obesity and with low CVRFs defined as the absence of cardiovascular disease (CVD), diabetes, hypertension, current smoking, and dyslipidemia were included. A CVRF-optimal subgroup was also defined, with blood pressure<120/80 mm Hg, fasting glucose <100 mg/dL, total cholesterol <200, low-density lipoprotein cholesterol <130, and women with high-density lipoprotein cholesterol ≥50 mg/dL. Coronary artery calcification, carotid intima-media thickness, left ventricular mass, left ventricular ejection fraction, longitudinal peak systolic strain, and diastolic function were assessed in midlife. Cox regression was used to calculate hazard ratios of BMI and WC for all-cause death and CVD events. Logistic regression was used to estimate odds ratios for subclinical CVD. Over 33.9 years (median follow-up), 5.2% (n=105) died, and 2.6% (n=52) had CVD events. Each 1-SD BMI increase was associated with 27% (95% CI, 1.10-1.47), 24% (1.08-1.43), 42% (1.20-1.68), 28% (1.05-1.57), 51% (1.20-1.90), and 49% (1.10-2.02) higher odds of coronary artery calcification presence, increased carotid intima-media thickness, left ventricular hypertrophy, reduced left ventricular ejection fraction, low longitudinal peak systolic strain, and diastolic dysfunction, respectively, in the CVRF-low group. Generally, similar associations were found for WC and in the CVRF-optimal subgroup. No significant associations between BMI and WC with CVD and death were found. CONCLUSIONS Elevations in BMI and WC among young low-risk individuals, even within the nonobesity range, are associated with midlife cardiovascular health.
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Affiliation(s)
- Soroush Masrouri
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Seyed Saeed Tamehri Zadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Siamak Afaghi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine Wake Forest University School of Medicine Winston Salem NC USA
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13
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Steding-Ehrenborg K, Nelsson A, Hedström E, Engblom H, Ingvarsson A, Nilsson J, Braun O, Arheden H. Diastolic Filling in Patients After Heart Transplantation Is Impaired Due to an Altered Geometrical Relationship Between the Left Atrium and Ventricle. J Am Heart Assoc 2024; 13:e033672. [PMID: 38780152 DOI: 10.1161/jaha.123.033672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The geometrical relationship between atrial and ventricular short-axis cross-sectional area determines the hydraulic forces acting on intracardiac blood. This is important for diastolic filling. In patients undergoing heart transplantation (HTx), the left atrium is often enlarged as a result of the standard surgical technique. We hypothesized that diastolic filling in HTx patients is affected by the surgery altering the geometrical relationship between atrium and ventricle. METHODS AND RESULTS This retrospective, cross-sectional study included 25 HTx patients (median age, 52 [range, 25-70] years), 15 patients with heart failure with reduced ejection fraction (median age, 63 [range, 52-75] years), 15 patients with heart failure with preserved ejection fraction (median age, 74 [range, 56-82] years), and 15 healthy controls (median age, 64 [range, 58-67] years) who underwent cardiac magnetic resonance imaging. Left ventricular, atrial, and total heart volumes (THV) were obtained. Atrioventricular area difference at end diastole and end systole was calculated as the largest ventricular short-axis area minus the largest atrial short-axis area. Left atrial minimum volume normalized for THV (LAmin/THV) was larger in HTx patients (median, 0.13 [range, 0.07-0.19]) compared with controls (median, 0.05 [range, 0.03-0.08], P <0.001), whereas left ventricular volume normalized for THV (left ventricular end-diastolic volume/THV) was similar between HTx and controls (median, 0.19 [range, 0.12-0.24] and median, 0.22 [range, 0.20-0.25], respectively). At end diastole, when atrioventricular area difference reached its largest positive value in controls, 11 HTx patients (44%) had a negative atrioventricular area difference, indicating impaired diastolic filling. CONCLUSIONS Diastolic filling is impaired in HTx patients due to an altered geometrical relationship between the left atrium and ventricle. When performing cardiac transplantation, a surgical technique that creates a smaller left atrium may improve diastolic filling by aiding hydraulic forces.
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Affiliation(s)
- Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Clinical Physiology Skåne University Hospital Lund Sweden
| | - Anders Nelsson
- Clinical Physiology, Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Clinical Physiology Skåne University Hospital Lund Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Clinical Physiology Skåne University Hospital Lund Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Radiology Skåne University Hospital Lund Sweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Clinical Physiology Skåne University Hospital Lund Sweden
| | - Annika Ingvarsson
- Cardiology, Department of Clinical Sciences Lund Lund University Lund Sweden
- Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine Skane University Hospital Lund Sweden
| | - Johan Nilsson
- Department of Translational Medicine, Artificial Intelligence and Bioinformatics in Cardiothoracic Sciences Research Unit Lund University Lund Sweden
- Department of Thoracic and Vascular Surgery Skảne University Hospital Lund Sweden
| | - Oscar Braun
- Cardiology, Department of Clinical Sciences Lund Lund University Lund Sweden
- Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine Skane University Hospital Lund Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund Lund University Lund Sweden
- Department of Clinical Physiology Skåne University Hospital Lund Sweden
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14
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Chandrasekhar S, Agrawal A. Diastology of the Transplanted Heart: Is the Geometrical Relationship of the Left Atrium the Missing Link? J Am Heart Assoc 2024; 13:e035545. [PMID: 38780178 DOI: 10.1161/jaha.124.035545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Affiliation(s)
- Sanjay Chandrasekhar
- Department of Cardiology, University of South Florida Tampa General Hospital Tampa FL USA
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15
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Palazzuoli A, Dini FL, Agostoni P, Cartocci A, Morrone F, Tricarico L, Correale M, Mercurio V, Nodari S, Severino P, Badagliacca R, Barillà F, Paolillo S, Filardi PP. Right ventricular dysfunction in chronic heart failure: clinical laboratory and echocardiographic characteristics. (the RIVED-CHF registry). J Cardiovasc Med (Hagerstown) 2024; 25:457-465. [PMID: 38652523 DOI: 10.2459/jcm.0000000000001623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Right ventricular dysfunction (RVD) and pulmonary hypertension have been recognized as two important prognostic features in patients with left side heart failure. Current literature does not distinguish between right heart failure (RHF) and RVD, and the two terms are used indiscriminately to describe pulmonary hypertension and RVD as well as clinical sign of RHF. Therefore, the right ventricle (RV) adaptation across the whole spectrum of left ventricular ejection fraction (LVEF) values has been poorly investigated. METHODS This is a multicenter observational prospective study endorsed by the Italian Society of Cardiology aiming to analyze the concordance between the signs and symptoms of RHF and echocardiographic features of RVD. The protocol will assess patients affected by chronic heart failure in stable condition regardless of the LVEF threshold by clinical, laboratory, and detailed echocardiographic study. During the follow-up period, patients will be observed by direct check-up visit and/or virtual visits every 6 months for a mean period of 3 years. All clinical laboratory and echocardiographic data will be recorded in a web platform system accessible for all centers included in the study. RESULTS The main study goals are: to investigate the concordance and discordance between clinical signs of RHF and RVD measured by ultrasonographic examination; to evaluate prognostic impact (in terms of cardiovascular mortality and heart failure hospitalization) of RVD and RHF during a mean follow-up period of 3 years; to investigate the prevalence of different right ventricular maladaptation (isolated right ventricular dilatation, isolated pulmonary hypertension, combined pattern) and the related prognostic impact. CONCLUSIONS With this protocol, we would investigate the three main RVD patterns according to heart failure types and stages; we would clarify different RVD and pulmonary hypertension severity according to the heart failure types. Additionally, by a serial multiparametric analysis of RV, we would provide a better definition of RVD stage and how much is it related with clinical signs of RHF (ClinicalTrials.gov Identifier: NCT06002321).
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Affiliation(s)
| | | | - PierGiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan
| | | | - Francesco Morrone
- UOSA Malattie Cardiovascolari, Le Scotte Hospital University of Siena
| | - Lucia Tricarico
- UO Cardiologia Universitaria -UTIC Policlinico Riuniti, Foggia
| | | | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples
| | - Savina Nodari
- Cardiology Unit Spedali riuniti di Brescia University of Brescia
| | - Paolo Severino
- Policlinico Umberto I UOC Cardiologia Università La Sapienza
| | | | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy
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16
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Chun KH, Kang SM. Blood pressure and heart failure: focused on treatment. Clin Hypertens 2024; 30:15. [PMID: 38822445 PMCID: PMC11143661 DOI: 10.1186/s40885-024-00271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/17/2024] [Indexed: 06/03/2024] Open
Abstract
Heart failure (HF) remains a significant global health burden, and hypertension is known to be the primary contributor to its development. Although aggressive hypertension treatment can prevent heart changes in at-risk patients, determining the optimal blood pressure (BP) targets in cases diagnosed with HF is challenging owing to insufficient evidence. Notably, hypertension is more strongly associated with HF with preserved ejection fraction than with HF with reduced ejection fraction. Patients with acute hypertensive HF exhibit sudden symptoms of acute HF, especially those manifested with severely high BP; however, no specific vasodilator therapy has proven beneficial for this type of acute HF. Since the majority of medications used to treat HF contribute to lowering BP, and BP remains one of the most important hemodynamic markers, targeted BP management is very concerned in treatment strategies. However, no concrete guidelines exist, prompting a trend towards optimizing therapies to within tolerable ranges, rather than setting explicit BP goals. This review discusses the connection between BP and HF, explores its pathophysiology through clinical studies, and addresses its clinical significance and treatment targets.
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Affiliation(s)
- Kyeong-Hyeon Chun
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Zacarias Rondinel T, Bocchi L, Cipriano Júnior G, Chiappa GRDS, Martins GDS, Mateus SRM, Cahalin LP, Cipriano GFB. Diaphragm thickness and mobility elicited by two different modalities of inspiratory muscle loading in heart failure participants: A randomized crossover study. PLoS One 2024; 19:e0302735. [PMID: 38787839 PMCID: PMC11125520 DOI: 10.1371/journal.pone.0302735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/02/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES To analyze diaphragmatic thickness, at end-inspiration and end-expiration, diaphragmatic thickening index and mobility via US under two different modalities of inspiratory muscle loading, in two different modalities of inspiratory muscle loading and different load intensities at full-vital capacity maneuvers and the relationship between diaphragmatic thickness with pulmonary function tests in participants with HF. METHODS This randomized crossover trial, enrolled with 17 HF subjects, evaluated diaphragm thickness (Tdi, mm), fractional thickness (TFdi, %), and mobility (mm) US during low and high intensities (30% and 60% of maximal inspiratory pressure-MIP) with two modalities of inspiratory muscle loading mechanical threshold loading (MTL) and tapered flow-resistive loading (TFRL). RESULTS Both MTL and TFRL produced a increase in Tdi, but only with high intensity loading compared to baseline-2.21 (0.26) vs. 2.68 (0.33) and 2.73 (0.44) mm; p = .01. TFdi was greater than baseline under all conditions, except during low intensity of TFRL. Diaphragm mobility was greater than baseline under all conditions, and high intensity of TFRL elicited greater mobility compared to all other conditions. Additionally, baseline Tdi was moderately correlated with pulmonary function tests. CONCLUSIONS MTL and TFRL modalities elicit similar increases in diaphragm thickness at loads, but only during high intensity loading it was greater than baseline. Diaphragm mobility was significantly greater than baseline under both loads and devices, and at high intensity compared to low intensity, although TFRL produced greater mobility compared to modalities of inspiratory muscle loading. There is an association between diaphragm thickness and pulmonary function tests.
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Affiliation(s)
- Tatiana Zacarias Rondinel
- Science and Technology in Health Program, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Lilian Bocchi
- Physical Therapy Department, Science of Rehabilitation Program, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Gerson Cipriano Júnior
- Physical Therapy Department, Science of Rehabilitation Program, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Gabriela de Sousa Martins
- Physical Therapy Department, Science of Rehabilitation Program, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Lawrence Patrick Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Coral Gables, Florida, United States of America
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Kerstens TP, Donker SC, Kleinnibbelink G, van Dijk AP, Oxborough D, Thijssen DHJ. Left and right ventricular strain-volume/area loops: a narrative review of current physiological understanding and potential clinical value. Echo Res Pract 2024; 11:12. [PMID: 38769555 PMCID: PMC11106969 DOI: 10.1186/s44156-024-00046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
Traditionally, echocardiography is used for volumetric measurements to aid in assessment of cardiac function. Multiple echocardiographic-based assessment techniques have been developed, such as Doppler ultrasound and deformation imaging (e.g., peak global longitudinal strain (GLS)), which have shown to be clinically relevant. Volumetric changes across the cardiac cycle can be related to deformation, resulting in the Ventricular Strain-Volume/Area Loop. These Loops allow assessment of the dynamic relationship between longitudinal strain change and volumetric change across both systole and diastole. This integrated approach to both systolic and diastolic function assessment may offer additional information in conjunction with traditional, static, measures of cardiac function or structure. The aim of this review is to summarize our current understanding of the Ventricular Strain-Volume/Area Loop, describe how acute and chronic exposure to hemodynamic stimuli alter Loop characteristics, and, finally, to outline the potential clinical value of these Loops in patients with cardiovascular disease. In summary, several studies observed Loop changes in different hemodynamic loading conditions and various (patho)physiological conditions. The diagnostic and prognostic value, and physiological interpretation remain largely unclear and have been addressed only to a limited extent.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Stijn Cm Donker
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom
| | - Geert Kleinnibbelink
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - Arie Pj van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom.
- Department of Medical BioSciences (928), Radboud University Medical Center, 6500HB, Nijmegen, P.O. Box 9101, The Netherlands.
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Katende A, Roos L, Urio VZ, Mahundi E, Myovela V, Mnzava D, Mlula C, Chitimbwa C, Raphael DM, Gingo W, Franzeck FC, Paris DH, Elzi L, Weisser M, Rohacek M. Recovery of left ventricular systolic function in peripartum cardiomyopathy: an observational study from rural Tanzania. BMC Cardiovasc Disord 2024; 24:243. [PMID: 38724901 PMCID: PMC11080156 DOI: 10.1186/s12872-024-03906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the recovery rate of the left ventricular systolic function of women diagnosed with peripartum cardiomyopathy receiving specialized care in rural Tanzania. METHODS In this observational study, women diagnosed with peripartum cardiomyopathy at a referral center in rural Tanzania between December 2015 and September 2021 were included. Women diagnosed between February and September 2021 were followed prospectively, those diagnosed between December 2015 and January 2021 were tracked back for a follow-up echocardiography. All participants received a clinical examination, a comprehensive echocardiogram, and a prescription of guideline-directed medical therapy. The primary outcome was recovery of the left ventricular systolic function (left ventricular ejection fraction > 50%). RESULTS Median age of the 110 participants was 28.5 years (range 17-45). At enrolment, 49 (45%) participants were already on cardiac medication, 50 (45%) had severe eccentric hypertrophy of the left ventricle, and the median left ventricular ejection fraction was 30% (range 15-46). After a median follow-up of 8.98 months (IQR 5.72-29.37), 61 (55%) participants were still on cardiac medication. Full recovery of the left ventricular systolic function was diagnosed in 76 (69%, 95% CI 59.6-77.6%) participants. In the multivariate analysis, a higher left ventricular ejection fraction at baseline was positively associated with full recovery (each 5% increase; OR 1.7, 95% CI 1.10-2.62, p = 0.012), while higher age was inversely associated (each 10 years increase; OR 0.40, 95% CI 0.19-0.82, p = 0.012). CONCLUSION Left ventricular systolic function recovered completely in 69% of study participants with peripartum cardiomyopathy from rural Tanzania under specialized care.
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Affiliation(s)
- Andrew Katende
- St. Francis Regional Referral Hospital, Ifakara, United Republic of Tanzania
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Laurine Roos
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Victor Z Urio
- St. Francis Regional Referral Hospital, Ifakara, United Republic of Tanzania
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Evance Mahundi
- St. Francis Regional Referral Hospital, Ifakara, United Republic of Tanzania
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Victor Myovela
- St. Francis Regional Referral Hospital, Ifakara, United Republic of Tanzania
| | - Dorcas Mnzava
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Chipegwa Mlula
- St. Francis Regional Referral Hospital, Ifakara, United Republic of Tanzania
| | | | - Dominick M Raphael
- St. Francis Regional Referral Hospital, Ifakara, United Republic of Tanzania
| | - Winfrid Gingo
- St. Francis Regional Referral Hospital, Ifakara, United Republic of Tanzania
| | - Fabian C Franzeck
- University of Basel, Basel, Switzerland
- Research and analytics services, University Hospital Basel, Basel, Switzerland
| | - Daniel H Paris
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Luigia Elzi
- Regional Hospital of Bellinzona e Valli, Bellinzona, Switzerland
| | - Maja Weisser
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Martin Rohacek
- St. Francis Regional Referral Hospital, Ifakara, United Republic of Tanzania.
- Ifakara Health Institute, Ifakara, United Republic of Tanzania.
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
- Swiss Tropical and Public Health Institute (Swiss TPH), Kreuzstrasse 2, Allschwil, 4123, Switzerland.
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20
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Bourg C, Le Tallec E, Curtis E, Lee C, Bouzille G, Oger E, Lescort A, Donal E. Heterogeneity of right ventricular echocardiographic parameters in systemic lupus erythematosus among four clinical subgroups, as stratified by clinical organ involvement in observational cohort. Open Heart 2024; 11:e002615. [PMID: 38702088 PMCID: PMC11086574 DOI: 10.1136/openhrt-2024-002615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease. Cardiac involvement in SLE is rare but plays an important prognostic role. The degree of cardiac involvement according to SLE subsets defined by non-cardiac manifestations is unknown. The objective of this study was to identify differences in transthoracic echocardiography (TTE) parameters associated with different SLE subgroups. METHODS One hundred eighty-one patients who fulfilled the 2019 American College of Rheumatology/EULAR classification criteria for SLE and underwent baseline TTE were included in this cross-sectional study. We defined four subsets of SLE based on the predominant clinical manifestations. A multivariate multinomial regression analysis was performed to determine whether TTE parameters differed between groups. RESULTS Four clinical subsets were defined according to non-cardiac clinical manifestations: group A (n=37 patients) showed features of mixed connective tissue disease, group B (n=76 patients) had primarily cutaneous involvement, group C (n=18) exhibited prominent serositis and group D (n=50) had severe, multi-organ involvement, including notable renal disease. Forty TTE parameters were assessed between groups. Per multivariate multinomial regression analysis, there were statistically significant differences in early diastolic tricuspid annular velocity (RV-Ea, p<0.0001), RV S' wave (p=0.0031) and RV end-diastolic diameter (p=0.0419) between the groups. Group B (primarily cutaneous involvement) had the lowest degree of RV dysfunction. CONCLUSION When defining clinical phenotypes of SLE based on organ involvement, we found four distinct subgroups which showed notable differences in RV function on TTE. Risk-stratifying patients by clinical phenotype could help better tailor cardiac follow-up in this population.
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Affiliation(s)
- Corentin Bourg
- Departement of Cardiology, CHU Rennes, Rennes, France
- Laboratoire du traitement du signal et de l'image LTSI, INSERM UMR 1099, Rennes, France
| | - Erwan Le Tallec
- Department of Internal Medicine and Clinical Immunology, University of Rennes 1, Rennes, France
| | | | - Charlotte Lee
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guillaume Bouzille
- Laboratoire du traitement du signal et de l'image LTSI, INSERM UMR 1099, Rennes, France
| | | | - Alain Lescort
- Department of Internal Medicine and Clinical Immunology, University of Rennes 1, Rennes, France
- Irset (Institut de Recherche en Santé Environnement et Travail)-UMR_S 1085, Rennes, France
| | - Erwan Donal
- Departement of Cardiology, CHU Rennes, Rennes, France
- Laboratoire du traitement du signal et de l'image LTSI, INSERM UMR 1099, Rennes, France
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21
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Lenselink C, Ricken KWLM, Groot HE, de Bruijne TJ, Hendriks T, van der Harst P, Voors AA, Lipsic E. Incidence and predictors of heart failure with reduced and preserved ejection fraction after ST-elevation myocardial infarction in the contemporary era of early percutaneous coronary intervention. Eur J Heart Fail 2024; 26:1142-1149. [PMID: 38576163 DOI: 10.1002/ejhf.3225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/11/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
AIMS The development and incidence of de-novo heart failure after ST-elevation myocardial infarction (STEMI) in the contemporary era of rapid reperfusion are largely unknown. We aimed to establish the incidence of post-STEMI heart failure, stratified by left ventricular ejection fraction (LVEF) and to find predictors for its occurrence. Furthermore, we investigated the course of left ventricular systolic and diastolic function after STEMI. METHODS AND RESULTS A total of 1172 all-comer STEMI patients from the CardioLines Biobank were included. Patients were predominantly male (74.5%) and 64 ± 12 years of age. During a median follow-up of 3.7 years (2.0, 5.5) we found a total incidence of post-STEMI heart failure of 10.9%, of which 52.1% heart failure with reduced ejection fraction (HFrEF), 29.4% heart failure with mildly reduced ejection fraction and 18.5% heart failure with preserved ejection fraction (HFpEF). Independent predictors for the development of HFrEF were male sex (β = 0.97, p = 0.009), lung crepitations (β = 1.09, p = 0.001), potassium level (mmol/L, β = 0.43, p = 0.012), neutrophil count (109/L, β = 0.09, p = 0.001) and a reduced LVEF (β = 1.91, p < 0.001) at baseline. Independent predictors for the development of HFpEF were female sex (β = 0.99, p = 0.029), pre-existing kidney failure (β = 1.95, p = 0.003) and greater left atrial volume index (β = 0.04, p = 0.033) at baseline. Follow-up echocardiography (median follow-up 20 months) showed an improvement in LVEF (p < 0.001), whereas changes in diastolic function parameters showed both improvement and deterioration. CONCLUSION In the current era of early STEMI reperfusion, still one in 10 patients develops heart failure, with approximately half of the patients with a reduced and half with a mildly reduced or normal LVEF. Predictors for the development of HFrEF were different from HFpEF.
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Affiliation(s)
- Chris Lenselink
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Kim W L M Ricken
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Hilde E Groot
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Tijs J de Bruijne
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Tom Hendriks
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Lipsic
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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22
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Aggarwal R, Potel KN, Jackson S, Lemke NT, Kelly RF, Soule M, Diaz-Gutierrez I, Shumway SJ, Patil J, Hertz M, Nijjar PS, Huddleston SJ. Impact of lung transplantation on diastolic dysfunction in recipients with pretransplant pulmonary hypertension. J Thorac Cardiovasc Surg 2024; 167:1643-1653.e2. [PMID: 37741317 DOI: 10.1016/j.jtcvs.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/09/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Pulmonary hypertension can cause left ventricular diastolic dysfunction through ventricular interdependence. Moreover, diastolic dysfunction has been linked to adverse outcomes after lung transplant. The impact of lung transplant on diastolic dysfunction in recipients with pretransplant pulmonary hypertension is not defined. In this cohort, we aimed to assess the prevalence of diastolic dysfunction, the change in diastolic dysfunction after lung transplant, and the impact of diastolic dysfunction on lung transplant outcomes. METHODS In a large, single-center database from January 2011 to September 2021, single or bilateral lung transplant recipients with pulmonary hypertension (mean pulmonary artery pressure > 20 mm Hg) were retrospectively identified. Those without a pre- or post-transplant echocardiogram within 1 year were excluded. Diastolic dysfunction was diagnosed and graded according to the American Society of Echocardiography 2016 guideline on assessment of diastolic dysfunction (present, absent, indeterminate). McNemar's test was used to examine association between diastolic dysfunction pre- and post-transplant. Kaplan-Meier and Cox regression analysis were used to assess associations between pre-lung transplant diastolic dysfunction and post-lung transplant 1-year outcomes, including mortality, major adverse cardiac events, and bronchiolitis obliterans syndrome grade 1 or higher-free survival. RESULTS Of 476 primary lung transplant recipients, 205 with pulmonary hypertension formed the study cohort (mean age, 56.6 ± 11.9 years, men 61.5%, mean pulmonary artery pressure 30.5 ± 9.8 mm Hg, left ventricular ejection fraction < 55% 9 [4.3%]). Pretransplant, diastolic dysfunction was present in 93 patients (45.4%) (grade I = 8, II = 84, III = 1), absent in 16 patients (7.8%), and indeterminate in 89 patients (43.4%), and 7 patients (3.4%) had missing data. Post-transplant, diastolic dysfunction was present in 7 patients (3.4%) (grade I = 2, II = 5, III = 0), absent in 164 patients (80.0%), and indeterminate in 15 patients (7.3%), and 19 patients (9.3%) had missing data. For those with diastolic dysfunction grades in both time periods (n = 180), there was a significant decrease in diastolic dysfunction post-transplant (148/169 patients with resolved diastolic dysfunction; McNemar's test P < .001). Pretransplant diastolic dysfunction was not associated with major adverse cardiac events (hazard ratio [HR], 1.08, 95% CI, 0.72-1.62; P = .71), bronchiolitis obliterans syndrome-free survival (HR, 0.67, 95% CI, 0.39-1.56; P = .15), or mortality (HR, 0.70, 95% CI, 0.33-1.46; P = .34) at 1 year. CONCLUSIONS Diastolic dysfunction is highly prevalent in lung transplant candidates with normal left ventricular systolic function and pulmonary hypertension, and resolves in most patients after lung transplant regardless of patient characteristics. Pre-lung transplant diastolic dysfunction was not associated with adverse lung or cardiac outcomes after lung transplant. Collectively, these findings suggest that the presence of diastolic dysfunction in lung transplant recipients with pulmonary hypertension has no prognostic significance, and as such diastolic dysfunction and the associated clinical syndrome of heart failure with preserved ejection fraction should not be considered a relative contraindication to lung transplant in such patients.
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Affiliation(s)
- Rishav Aggarwal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Koray N Potel
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Scott Jackson
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minn
| | - Nicholas T Lemke
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Rosemary F Kelly
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Matthew Soule
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Ilitch Diaz-Gutierrez
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Sara J Shumway
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Jagadish Patil
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minn
| | - Marshall Hertz
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minn
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minn
| | - Stephen J Huddleston
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn.
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23
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Jani VP, Mukherjee M. The Scleroderma Tango: Unraveling the Delicate Dance of Diastolic Dysfunction and Interstitial Lung Disease. J Rheumatol 2024; 51:440-441. [PMID: 38428962 PMCID: PMC11182489 DOI: 10.3899/jrheum.2024-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Vivek P Jani
- V.P. Jani, MS, M. Mukherjee, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Monica Mukherjee
- V.P. Jani, MS, M. Mukherjee, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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24
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Aronson D, Sliman H, Abadi S, Maiorov I, Perlow D, Mutlak D, Lessick J. Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction. Circ Cardiovasc Imaging 2024; 17:e016276. [PMID: 38716653 PMCID: PMC11111319 DOI: 10.1161/circimaging.123.016276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/14/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Quantification of left atrial (LA) conduit function and its contribution to left ventricular (LV) filling is challenging because it requires simultaneous measurements of both LA and LV volumes. The functional relationship between LA conduit function and the severity of diastolic dysfunction remains controversial. We studied the role of LA conduit function in maintaining LV filling in advanced diastolic dysfunction. METHODS We performed volumetric and flow analyses of LA function across the spectrum of LV diastolic dysfunction, derived from a set of consecutive patients undergoing multiphasic cardiac computed tomography scanning (n=489). From LA and LV time-volume curves, we calculated 3 volumetric components: (1) early passive emptying volume; (2) late active (booster) volume; and (3) conduit volume. Results were prospectively validated on a group of patients with severe aortic stenosis (n=110). RESULTS The early passive filling progressively decreased with worsening diastolic function (P<0.001). The atrial booster contribution to stroke volume modestly increases with impaired relaxation (P=0.021) and declines with more advanced diastolic function (P<0.001), thus failing to compensate for the reduction in early filling. The conduit volume increased progressively (P<0.001), accounting for 75% of stroke volume (interquartile range, 63-81%) with a restrictive filling pattern, compensating for the reduction in both early and booster functions. Similar results were obtained in patients with severe aortic stenosis. The pulmonary artery systolic pressure increased in a near-linear fashion when the conduit contribution to stroke volume increased above 60%. Maximal conduit flow rate strongly correlated with mitral E-wave velocity (r=0.71; P<0.0001), indicating that the increase in mitral E wave in diastolic dysfunction represents the increased conduit flow. CONCLUSIONS An increase in conduit volume contribution to stroke volume represents a compensatory mechanism to maintain LV filling in advanced diastolic dysfunction. The increase in conduit volume despite increasing LV diastolic pressures is accomplished by an increase in pulmonary venous pressure.
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Affiliation(s)
- Doron Aronson
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine (D.A., S.A., D.M., J.L.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hend Sliman
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
| | - Sobhi Abadi
- Medical Imaging (S.A.), Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine (D.A., S.A., D.M., J.L.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ida Maiorov
- BioMedical Engineering (I.M.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniel Perlow
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
| | - Diab Mutlak
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine (D.A., S.A., D.M., J.L.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jonathan Lessick
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine (D.A., S.A., D.M., J.L.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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25
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Meucci MC, Lillo R, Mango F, Marsilia M, Iannaccone G, Tusa F, Luigetti M, Biagini E, Massetti M, Lanza GA, Lombardo A, Graziani F. Left atrial structural and functional remodelling in Fabry disease and cardiac amyloidosis: A comparative analysis. Int J Cardiol 2024; 402:131891. [PMID: 38382852 DOI: 10.1016/j.ijcard.2024.131891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Fabry disease (FD) and transthyretin cardiac amyloidosis (TTR CA) are cardiomyopathies with hypertrophic phenotype that share several features, including left atrial (LA) enlargement and dysfunction, but direct comparative data are lacking. Aim of the present study was to perform a comparative analysis of LA remodelling between the two diseases. METHODS AND RESULTS In this prospective study, a total of 114 patients (31 FD and 83 TTR CA) were included; all of them had left ventricular hypertrophy (LVH), defined as left ventricular (LV) wall thickness ≥ 12 mm. Despite similar degree of LVH, patients with TTR CA showed worse LV systolic and diastolic function. LA maximal volume index was not significantly different between the two groups (p = 0.084), while patients with TTR CA showed larger LA minimal volume index (p = 0.001). Moreover, all phases of LA mechanics were more impaired in the TTR CA group vs FD (reservoir: 6.9[4.2-15.5] vs 19.0[15.5-29.5], p < 0.001). After excluding patients with atrial fibrillation (AF), these differences remained clearly significant. In multivariable regression analyses, LA reservoir strain showed an independent correlation with TTR CA, controlling for demographic characteristics, AF and LV systolic and diastolic performance (p ≤ 0.001), whereas LV global longitudinal strain did not. Finally, among echocardiographic parameters, LA function demonstrated the highest accuracy in discriminating the two diseases. CONCLUSIONS TTR CA is characterized by a more advanced LA structural and functional remodelling in comparison to patients with FD and similar degree of LVH. The association between TTR CA and LA dysfunction remains consistent after adjustment for potential confounders.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Rosa Lillo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Mango
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Marsilia
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Tusa
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Luigetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Rome, Italy; Università Cattolica del Sacro Cuore, Dipartimento di Neuroscienze, Rome, Italy
| | - Elena Biagini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Massimo Massetti
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.
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26
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Omar AMS, Murphy S, Felker GM, Piña I, Butler J, Liu Y, Mohebi R, Bhatia K, Ward JH, Williamson KM, Solomon SD, Januzzi JL, Contreras J. Isovolumic Contraction Velocity in Heart Failure With Reduced Ejection Fraction and Effect of Sacubitril/Valsartan: the PROVE-HF Study. J Card Fail 2024; 30:653-665. [PMID: 37816446 DOI: 10.1016/j.cardfail.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES To assess tissue Doppler-derived mitral annular isovolumic contraction velocity (ICV) after starting sacubitril/valsartan (sac/val) for the treatment of heart failure with reduced ejection fraction (HFrEF) and left ventricular [LV] EF < 40%). BACKGROUND ICV may inform load-independent systolic function; combining ICV and LVEF may improve assessment of LV contractility. METHODS Among 651 participants with HFrEF treated with sac/val, echocardiograms were performed at baseline, 6 and 12 months. Pretreatment median ICVs and LVEFs were used for classification to predict LV reverse remodeling, health status using the Kansas City Cardiomyopathy Questionnaire, and biomarker concentrations. RESULTS The mean age was 64.6 ± 12.4 years, and 28% were women, baseline LVEF: 28.9% ± 6.9%. Compared to baseline, median ICV increased post sac/val therapy (4.6 [3.5, 6.1] vs 4.9 [3.6, 6.4]; P = 0.005). ICV added value to separate and combined models of biomarkers and clinical and echocardiographic variables for prediction of post-therapy EF recovery. Classification using baseline ICV/EF yielded relatively equal numbers in 4 groups based on low/high ICV or LVEF. Most deleterious results for remodeling, health status and biomarkers were found in patients with low ICV/low EF, whereas patients with high ICV/high EF had the best profiles; other groups were intermediate. Significant shifts toward better ICV/EF profiles were noted post sac/val treatment compared to baseline, with doubling of high ICV/high EF (241 [60%] vs 123 [31%]) and 78% reduction of low ICV/low EF (28 [7%] vs 125 [32%]). CONCLUSIONS In HFrEF, ICV adds to the profiling of systolic function and represents an independent predictor of reverse cardiac remodeling after treatment with sac/val. ICV changes may be used for assessment of treatment responses.
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Affiliation(s)
| | | | | | - Ileana Piña
- Thomas Jefferson University, Philadelphia, PA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX; University of Mississippi, Jackson, MS
| | - Yuxi Liu
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Reza Mohebi
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Kirtipal Bhatia
- Department of Cardiovascular Medicine, Mount Sinai Morningside, New York, NY
| | | | | | - Scott D Solomon
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston. Baim Institute for Clinical Research, Boston, MA.
| | - Johanna Contreras
- Department of Cardiovascular Medicine, Mount Sinai Health System, New York, NY
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Ferreira AF, Azevedo MJ, Morais J, Almeida-Coelho J, Leite-Moreira AM, Lourenço AP, Saraiva F, Diaz SO, Amador AF, Sousa C, Machado AP, Sampaio-Maia B, Ramalho C, Leite-Moreira A, Barros AS, Falcão-Pires I. Stretch-induced compliance mechanism in pregnancy-induced cardiac hypertrophy and the impact of cardiovascular risk factors. Am J Physiol Heart Circ Physiol 2024; 326:H1193-H1203. [PMID: 38334973 DOI: 10.1152/ajpheart.00701.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
Pressure overload-induced hypertrophy compromises cardiac stretch-induced compliance (SIC) after acute volume overload (AVO). We hypothesized that SIC could be enhanced by physiological hypertrophy induced by pregnancy's chronic volume overload. This study evaluated SIC-cardiac adaptation in pregnant women with or without cardiovascular risk (CVR) factors. Thirty-seven women (1st trimester, 1stT) and a separate group of 31 (3rd trimester, 3rdT) women [healthy or with CVR factors (obesity and/or hypertension and/or with gestational diabetes)] underwent echocardiography determination of left ventricular end-diastolic volume (LVEDV) and E/e' before (T0), immediately after (T1), and 15 min after (T2; SIC) AVO induced by passive leg elevation. Blood samples for NT-proBNP quantification were collected before and after the AVO. Acute leg elevation significantly increased inferior vena cava diameter and stroke volume from T0 to T1 in both 1stT and 3rdT, confirming AVO. LVEDV and E/e' also increased immediately after AVO (T1) in both 1stT and 3rdT. SIC adaptation (T2, 15 min after AVO) significantly decreased E/e' in both trimesters, with additional expansion of LVEDV only in the 1stT. NT-pro-BNP increased slightly after AVO but only in the 1stT. CVR factors, but not parity or age, significantly impacted SIC cardiac adaptation. A distinct functional response to SIC was observed between 1stT and 3rdT, which was influenced by CVR factors. The LV of 3rdT pregnant women was hypertrophied, showing a structural limitation to dilate with AVO, whereas the lower LV filling pressure values suggest increased diastolic compliance.NEW & NOTEWORTHY The sudden increase of volume overload triggers an acute myocardial stretch characterized by an immediate rise in contractility by the Frank-Starling mechanism, followed by a progressive increase known as the slow force response. The present study is the first to characterize echocardiographically the stretch-induced compliance (SIC) mechanism in the context of physiological hypertrophy induced by pregnancy. A distinct functional adaptation to SIC was observed between first and third trimesters, which was influenced by cardiovascular risk factors.
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Affiliation(s)
- Ana Filipa Ferreira
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria João Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
- Instituto Nacional de Engenharia Biomédica, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Juliana Morais
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Almeida-Coelho
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André M Leite-Moreira
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Anesthesiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - André P Lourenço
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Anesthesiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sílvia O Diaz
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Filipa Amador
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Sousa
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Paula Machado
- Obstetrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Benedita Sampaio-Maia
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
- Instituto Nacional de Engenharia Biomédica, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Carla Ramalho
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Obstetrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Obstetrics, Gynaecology and Pediatrics Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António S Barros
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Kim G, Yu TY, Jee JH, Bae JC, Kang M, Kim JH. Association between nonalcoholic fatty liver disease and left ventricular diastolic dysfunction: A 7-year retrospective cohort study of 3,380 adults using serial echocardiography. DIABETES & METABOLISM 2024; 50:101534. [PMID: 38608865 DOI: 10.1016/j.diabet.2024.101534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
AIM Left ventricular diastolic dysfunction (LVDD) has been observed in people with nonalcoholic fatty liver disease (NAFLD) in cross-sectional studies but the causal relationship is unclear. This study aimed to investigate the impact of NAFLD and the fibrotic progression of the disease on the development of LVDD, assessed by serial echocardiography, in a large population over a 7-year longitudinal setting. METHODS This retrospective cohort study included the data of 3,380 subjects from a medical health check-up program. We defined subjects having NAFLD by abdominal ultrasonography and assessed significant liver fibrosis by the aspartate transaminase (AST) to platelet ratio index (APRI), the NAFLD fibrosis score (NFS), and the fibrosis-4 (FIB-4) index. LVDD was defined using serial echocardiography. A parametric Cox proportional hazards model was used. RESULTS During 11,327 person-years of follow-up, there were 560 (16.0 %) incident cases of LVDD. After adjustment for multiple risk factors, subjects with NAFLD showed an increased adjusted hazard ratio (aHR) of 1.21 (95 % confidence interval [CI]=1.02-1.43) for incident LVDD compared to those without. The risk of LV diastolic dysfunction increased progressively with increasing degree of hepatic steatosis (P< 0.001). Compared to subjects without NAFLD, the multivariable-aHR (95 % CI) for LVDD in subjects with APRI < 0.5 and APRI ≥ 0.5 were 1.20 (1.01-1.42) and 1.36 (0.90-2.06), respectively (P= 0.036), while other fibrosis prediction models (NFS and FIB-4 index) showed insignificant results. CONCLUSIONS This study demonstrated that NAFLD was associated with an increased risk of LVDD in a large cohort. More severe forms of hepatic steatosis and/or significant liver fibrosis may increase the risk of developing LVDD.
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Affiliation(s)
- Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Yang Yu
- Division of Endocrinology and Metabolism, Department of Medicine, Wonkwang Medical Center, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jae Hwan Jee
- Department of Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Cheol Bae
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Mira Kang
- Department of Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Republic of Korea.
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Spencer L, Wright L, Foulkes SJ, Rowe SJ, Dillon HT, Climie R, Bigaran A, Janssens K, Mitchell A, Wallace I, Lindqvist A, Burnham L, Prior DL, Howden EJ, La Gerche A. Characterizing the influence of cardiorespiratory fitness on left atrial size and function in the general population. Am J Physiol Heart Circ Physiol 2024; 326:H1269-H1278. [PMID: 38457351 DOI: 10.1152/ajpheart.00422.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 03/10/2024]
Abstract
Increased left atrial (LA) size and reduced LA function have been associated with heart failure and atrial fibrillation (AF) in at-risk populations. However, atrial remodeling has also been associated with exercise training and the relationship between fitness, LA size, and function has not been defined across the fitness spectrum. In a cross-sectional study of 559 ostensibly healthy participants, comprising 304 males (mean age, 46 ± 20 yr) and 255 females (mean age, 47 ± 15 yr), we sought to define the relationship between cardiorespiratory fitness (CRF), LA size, and function. We also aimed to interrogate sex differences in atrial factors influencing CRF. Echocardiographic measures included biplane measures of LA volumes indexed to body surface area (LAVi) and atrial deformation using two-dimensional speckle tracking. CRF was measured as peak oxygen consumption (V̇o2peak) during cardiopulmonary exercise testing (CPET). Using multivariable regression, age, sex, weight, and LAVi (P < 0.001 for all) predicted V̇o2peak (P < 0.001, R2 = 0.66 for combined model). After accounting for these variables, heart rate reserve added strength to the model (P < 0.001, R2 = 0.74) but LA strain parameters did not predict V̇o2peak. These findings add important nuance to the perception that LA size is a marker of cardiac pathology. LA size should be considered in the context of fitness, and it is likely that the adverse prognostic associations of increased LA size may be confined to those with LA enlargement and low fitness.NEW & NOTEWORTHY Left atrial (LA) structure better predicts cardiorespiratory fitness (CRF) than LA function. LA function adds little statistical value to predictive models of peak oxygen uptake (V̇o2peak) in healthy individuals, suggesting limited discriminatory for CRF once LA size is factored. In the wider population of ostensibly healthy individuals, the association between increased LA volume and higher CRF provides an important counter to the association between atrial enlargement and heart failure symptoms in those with cardiac pathology.
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Affiliation(s)
- Luke Spencer
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Stephanie J Rowe
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Hayley T Dillon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Rachel Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Kristel Janssens
- St Vincent's Institute, Fitzroy, Victoria, Australia
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Amy Mitchell
- St Vincent's Institute, Fitzroy, Victoria, Australia
| | - Imogen Wallace
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Lauren Burnham
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David L Prior
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Erin J Howden
- University of Melbourne, Parkville, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Victor Chang Cardiac Research Centre, Darlinghurst, New South Wales, Australia
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30
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Fairley JL, Hansen D, Burns A, Prior D, La Gerche A, Morrisroe K, Stevens W, Nikpour M, Ross LJ. Contribution of Left Ventricular Diastolic Dysfunction to Survival and Breathlessness in Systemic Sclerosis-Associated Interstitial Lung Disease. J Rheumatol 2024; 51:495-504. [PMID: 38224991 DOI: 10.3899/jrheum.2023-0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To explore the effect of left ventricular (LV) diastolic dysfunction (LVDD) in systemic sclerosis (SSc)-associated interstitial lung disease (ILD), and to investigate SSc-specific associations and clinical correlates of LVDD. METHODS There were 102 Australian Scleroderma Cohort Study participants with definite SSc and radiographic ILD included. Diastolic function was classified as normal, indeterminate, or abnormal according to 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines for assessment of LV diastolic function. Associations between clinical features and patient- and physician-reported dyspnea were evaluated using logistic regression. Survival analyses were performed using Kaplan-Meier survival estimates and Cox regression modeling. RESULTS LVDD was identified in 26% of participants, whereas 19% had indeterminate and 55% had normal diastolic function. Those with ILD and LVDD had increased mortality (hazard ratio 2.4, 95% CI 1.0-5.7; P = 0.05). After adjusting for age and sex, those with ILD and LVDD were more likely to have severe dyspnea on the Borg Dyspnoea Scale (odds ratio [OR] 2.6, 95% CI 1.0-6.6; P = 0.05) and numerically more likely to record World Health Organization Function Class II or higher dyspnea (OR 4.2, 95% CI 0.9-20.0; P = 0.08). Older age (95% CI 1.0-6.4; P = 0.05), hypertension (OR 5.0, 95% CI 1.8-13.8; P < 0.01), and ischemic heart disease (OR 4.8, 95% CI 1.5-15.7; P < 0.01) were all associated with LVDD, as was proximal muscle atrophy (OR 5.0, 95% CI 1.9-13.6; P < 0.01) and multimorbidity (Charlson Comorbidity Index scores ≥ 4, OR 3.0, 95% CI 1.1-8.7; P = 0.04). CONCLUSION LVDD in SSc-ILD is more strongly associated with traditional LVDD risk factors than SSc-specific factors. LVDD is associated with worse dyspnea and survival in those with SSc-ILD.
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MESH Headings
- Humans
- Female
- Dyspnea/etiology
- Dyspnea/physiopathology
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/mortality
- Scleroderma, Systemic/physiopathology
- Lung Diseases, Interstitial/mortality
- Lung Diseases, Interstitial/physiopathology
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/complications
- Male
- Middle Aged
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/mortality
- Aged
- Australia/epidemiology
- Adult
- Echocardiography
- Diastole
- Cohort Studies
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Affiliation(s)
- Jessica L Fairley
- J.L. Fairley, MBBS, A. Burns, PhD, D. Prior, PhD, K. Morrisroe, PhD, M. Nikpour, PhD, L.J. Ross, PhD, The University of Melbourne, and St. Vincent's Hospital Melbourne
| | - Dylan Hansen
- D. Hansen, MBiostat, W. Stevens, MBBS, St. Vincent's Hospital Melbourne
| | - Andrew Burns
- J.L. Fairley, MBBS, A. Burns, PhD, D. Prior, PhD, K. Morrisroe, PhD, M. Nikpour, PhD, L.J. Ross, PhD, The University of Melbourne, and St. Vincent's Hospital Melbourne
| | - David Prior
- J.L. Fairley, MBBS, A. Burns, PhD, D. Prior, PhD, K. Morrisroe, PhD, M. Nikpour, PhD, L.J. Ross, PhD, The University of Melbourne, and St. Vincent's Hospital Melbourne
| | - André La Gerche
- A. La Gerche, PhD, The University of Melbourne, and St. Vincent's Hospital Melbourne, and Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. M. Nikpour and L. Ross contributed equally to this work
| | - Kathleen Morrisroe
- J.L. Fairley, MBBS, A. Burns, PhD, D. Prior, PhD, K. Morrisroe, PhD, M. Nikpour, PhD, L.J. Ross, PhD, The University of Melbourne, and St. Vincent's Hospital Melbourne
| | - Wendy Stevens
- D. Hansen, MBiostat, W. Stevens, MBBS, St. Vincent's Hospital Melbourne
| | - Mandana Nikpour
- J.L. Fairley, MBBS, A. Burns, PhD, D. Prior, PhD, K. Morrisroe, PhD, M. Nikpour, PhD, L.J. Ross, PhD, The University of Melbourne, and St. Vincent's Hospital Melbourne;
| | - Laura J Ross
- J.L. Fairley, MBBS, A. Burns, PhD, D. Prior, PhD, K. Morrisroe, PhD, M. Nikpour, PhD, L.J. Ross, PhD, The University of Melbourne, and St. Vincent's Hospital Melbourne
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Nguyen MB, Venet M, Fan CPS, Dragulescu A, Rusin CG, Mertens LL, Mital S, Villemain O. Modeling the Relationship Between Diastolic Phenotype and Outcomes in Pediatric Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2024; 37:508-517.e3. [PMID: 38097053 DOI: 10.1016/j.echo.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Pediatric hypertrophic cardiomyopathy (HCM) is associated with adverse events. The contribution of diastolic dysfunction to adverse events is poorly understood. The aim of this study was to explore the association between diastolic phenotype and outcomes in pediatric patients with HCM. METHODS Children <18 years of age with diagnosed with HCM were included. Diastolic function parameters were measured from the first echocardiogram at the time of diagnosis, including Doppler flow velocities, tissue Doppler velocities, and left atrial volume and function. Using principal-component analysis, key features in echocardiographic parameters were identified. The principal components were regressed to freedom from major adverse cardiac events (MACE), defined as implantable cardioverter-defibrillator insertion, myectomy, aborted sudden cardiac death, transplantation, need for mechanical circulatory support, and death. RESULTS Variables that estimate left ventricular filling pressures were highly collinear and associated with MACE (hazard ratio, 0.86; 95% CI, 0.75-1.00), though this was no longer significant after controlling for left ventricular thickness and genetic variation. Left atrial size parameters adjusted for body surface area were independently associated with outcomes in the covariate-adjusted model (hazard ratio, 0.69; 95% CI, 0.5-0.94). The covariate-adjusted model had an Akaike information criterion of 213, an adjusted R2 value of 0.78, and a concordance index of 0.82 for association with MACE. CONCLUSION Echocardiographic parameters of diastolic dysfunction were associated with MACE in this population study, in combination with the severity of left ventricular hypertrophy and genetic variation. Left atrial size parameters adjusted for body surface area were independently associated with adverse events. Additional study of diastolic function parameters adjusted for patient size could facilitate the prediction of adverse events in pediatric patients with HCM.
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Affiliation(s)
- Minh B Nguyen
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas; Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Maelys Venet
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Andreea Dragulescu
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Craig G Rusin
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas
| | - Luc L Mertens
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Seema Mital
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Olivier Villemain
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Schmitt A, Behnes M, Rusnak J, Akin M, Reinhardt M, Abel N, Forner J, Müller J, Weidner K, Abumayyaleh M, Akin I, Schupp T. Characteristics Associated with Ventricular Tachyarrhythmias and Their Prognostic Impact in Heart Failure with Mildly Reduced Ejection Fraction. J Clin Med 2024; 13:2665. [PMID: 38731194 PMCID: PMC11084292 DOI: 10.3390/jcm13092665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/19/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The occurrence of ventricular tachyarrhythmias represents an established risk factor of mortality in heart failure (HF). However, data concerning their prognostic impact in heart failure with mildly reduced ejection fraction (HFmrEF) is limited. Therefore, the present study aims to investigate patient characteristics associated with ventricular tachyarrhythmias and their prognostic impact in patients with HFmrEF. Methods: Consecutive patients hospitalized with HFmrEF (i.e., left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. The prognosis of patients with HFmrEF and different types of ventricular tachyarrhythmias (i.e., non-sustained ventricular tachycardia (nsVT), sustained VT (sVT), and ventricular fibrillation (VF) was investigated for the primary endpoint of long-term all-cause mortality at 30 months. Secondary endpoints included in-hospital all-cause mortality and long-term HF-related rehospitalization at 30 months. Results: From a total of 2184 patients with HFmrEF, 4.4% experienced ventricular tachyarrhythmias (i.e., 2.0% nsVT, 0.7% sVT, and 1.6% VF). The occurrence of nsVT was associated with higher New York Heart Association (NYHA) functional class, whereas the incidence of sVT/VF was associated with acute myocardial infarction and ischemic heart disease. However, nsVT (25.0%; HR = 0.760; 95% CI 0.419-1.380; p = 0.367) and sVT/VF (28.8%; HR = 0.928; 95% CI 0.556-1.549; p = 0.776) were not associated with a higher risk of long-term all-cause mortality compared to patients with HFmrEF without ventricular tachyarrhythmias (31.5%). In-hospital cardiovascular mortality was more frequently observed in patients with HFmrEF and sVT/VF compared to those with HFmrEF but without sustained ventricular tachyarrhythmias (7.7% vs. 1.5%; p = 0.004). Finally, the risk of rehospitalization for worsening HF was not affected by the presence of ventricular tachyarrhythmias. Conclusions: The occurrence of ventricular tachyarrhythmias in patients hospitalized with HFmrEF was low and not associated with long-term prognosis.
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Affiliation(s)
- Alexander Schmitt
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69047 Heidelberg, Germany
| | - Muharrem Akin
- Department of Cardiology, St. Josef-Hospital, Ruhr-Universität Bochum, 44791 Bochum, Germany
| | - Marielen Reinhardt
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Noah Abel
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Jan Forner
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Julian Müller
- Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Kathrin Weidner
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
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33
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Krug P, Geets X, Berlière M, Duhoux F, Beauloye C, Pasquet A, Vancraeynest D, Pouleur AC, Gerber BL. Cardiac structure, function, and coronary anatomy 10 years after isolated contemporary adjuvant radiotherapy in breast cancer patients with low cardiovascular baseline risk. Eur Heart J Cardiovasc Imaging 2024; 25:645-656. [PMID: 38128112 DOI: 10.1093/ehjci/jead338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
AIMS The effects of isolated contemporary low-dose breast cancer (BC) radiotherapy (RT) on the heart remain poorly understood. This study aims to assess the long-term impacts of BC-RT on cardiac structure and function. METHODS AND RESULTS Seventy-six women (62 ± 7 years) without history of prior heart disease, who had undergone RT for either first left (n = 36) or right (n = 40) BC, without additional medical oncology therapy apart from hormonal treatment 11 ± 1 years earlier, underwent transthoracic echocardiography, cardiac magnetic resonance imaging (CMR), computed tomography coronary angiography (CTCA), NT-proBNP, and a 6-min walk test (6MWT). They were compared with 54 age-matched healthy female controls. By CTCA, 68% of BC patients exhibited no or very mild coronary disease, while only 11% had moderate stenosis (50-69%) and 3% had significant stenosis (>70%). Despite slightly reduced regional echocardiographic midventricular strains, BC patients exhibited similar global left and right ventricular volumes, ejection fractions, and global strains by echocardiography and CMR as controls. Mitral E/e' ratios were slightly higher, and mitral deceleration times were slightly lower, but NT-proBNP was similar to controls. Also, 6MWT was normal. None had late gadolinium enhancement, and extracellular volume fraction was similar in BC (28 ± 3 vs. 29 ± 3, P = 0.15) and controls. No differences were observed relative to dose or side of RT. CONCLUSION Aside from minor alterations of regional strains and diastolic parameters, women who received isolated RT for BC had low prevalence of coronary disease, normal global systolic function, NT-proBNP, and exercise capacity and showed no structural changes by CMR, refuting significant long-term cardiotoxicity in such low-risk patients.
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Affiliation(s)
- Pauline Krug
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St.Luc, Av Hippocrate 10/2806, B-1200 Woluwe-Saint-Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Avenue Hippocrate, 55 bte B1.55.02 Université Catholique de Louvain (UCLouvain), B-1200 Woluwe St. Lambert, Belgium
| | - Xavier Geets
- Division of Radiotherapy, Cliniques Universitaires St.Luc, Av Hippocrate 10/2806, B-1200 Woluwe-Saint-Lambert, Belgium
- Pole d'Imagerie Médicale, Radiothérapie et Oncologie (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 54/B1.54.07, B-1200 Woluwe St. Lambert, Belgium
| | - Martine Berlière
- Division of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires St.Luc, Brussels, Belgium
- Pôle de Gynécologie (GYNE), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Avenue Mounier 52 bte B1.52.02, B1200 Woluwe St Lambert, Belgium
| | - François Duhoux
- Pole d'Imagerie Médicale, Radiothérapie et Oncologie (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 54/B1.54.07, B-1200 Woluwe St. Lambert, Belgium
- Division of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires St.Luc, Brussels, Belgium
| | - Christophe Beauloye
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St.Luc, Av Hippocrate 10/2806, B-1200 Woluwe-Saint-Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Avenue Hippocrate, 55 bte B1.55.02 Université Catholique de Louvain (UCLouvain), B-1200 Woluwe St. Lambert, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St.Luc, Av Hippocrate 10/2806, B-1200 Woluwe-Saint-Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Avenue Hippocrate, 55 bte B1.55.02 Université Catholique de Louvain (UCLouvain), B-1200 Woluwe St. Lambert, Belgium
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St.Luc, Av Hippocrate 10/2806, B-1200 Woluwe-Saint-Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Avenue Hippocrate, 55 bte B1.55.02 Université Catholique de Louvain (UCLouvain), B-1200 Woluwe St. Lambert, Belgium
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St.Luc, Av Hippocrate 10/2806, B-1200 Woluwe-Saint-Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Avenue Hippocrate, 55 bte B1.55.02 Université Catholique de Louvain (UCLouvain), B-1200 Woluwe St. Lambert, Belgium
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St.Luc, Av Hippocrate 10/2806, B-1200 Woluwe-Saint-Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Avenue Hippocrate, 55 bte B1.55.02 Université Catholique de Louvain (UCLouvain), B-1200 Woluwe St. Lambert, Belgium
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Gąsior T, Zaborska B, Stachowiak P, Sikora-Frąc M, Mizia-Stec K, Kasprzak J, Bodys A, Bijoch J, Szmagała A, Kosior DA, Płońska-Gościniak E. Echocardiographic Assessment of Left Ventricular Function in Three Oncologic Therapeutic Modalities in Women with Breast Cancer: The ONCO-ECHO Multicenter Study. J Clin Med 2024; 13:2543. [PMID: 38731072 PMCID: PMC11084324 DOI: 10.3390/jcm13092543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Oncological treatment of breast cancer may be associated with adverse effects on myocardial function. Objectives: The objective of this study was to compare the influence of three oncological treatment methods of intervention on the echocardiographic (ECHO) parameters of left ventricular function. Materials and Methods: One hundred and fifty-five women with breast cancer were divided into three groups depending on the type of therapy used: group I (AC)-anthracyclines; group II (AC + TZ)-anthracyclines + trastuzumab; and group III (RTls+)-anthracyclines with or without trastuzumab + left-sided radiotherapy. Prospective ECHO examinations were performed at baseline and every 3 months, up to 12 months from the start of the therapy. Patients with a history of chemotherapy or who were diagnosed with heart disease were not included in the study. Results: Out of 155 patients, 3 died due to cancer as the primary cause, and 12 withdrew their consent for further observation. Baseline systolic and diastolic ECHO parameters did not differ between the analyzed groups. Cardiotoxicity, according to the LVEF criteria, occurred during follow-up in 20 patients (14.3%), irrespective of the treatment method used. Diastolic echocardiographic parameters did not change significantly after 12 months in each group, except for the left atrial volume index (LAVi), which was significantly higher in the AC + TZ compared to the values in the RTls+ group. Conclusions: All three oncologic therapeutic modalities in women with breast cancer showed no significant differences in relation to the incidence of echocardiographic cardiotoxicity criterion; however, transient systolic decrease in LVEF was most frequently observed in the AC + TZ therapeutic regimen. Left-sided radiotherapy was not associated with excess left ventricular systolic and diastolic dysfunction during a 12-month follow-up period. The predictors of negative changes in diastolic parameters included age and combined anthracycline and trastuzumab therapy.
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Affiliation(s)
- Tomasz Gąsior
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
- Boehringer Ingelheim International GmbH, 55218 Ingelheim, Germany
| | - Beata Zaborska
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland
| | - Paweł Stachowiak
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Małgorzata Sikora-Frąc
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland
| | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jarosław Kasprzak
- Department of Cardiology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Artur Bodys
- Stefan Cardinal Wyszynski Regional Hospital, 20-468 Lublin, Poland
| | - Julia Bijoch
- Collegium Medicum—Faculty of Medicine, WSB University, 41-300 Dabrowa Gornicza, Poland
| | - Adrianna Szmagała
- Xth Department of Invasive Cardiology, Electrophysiology and Electrostimulation, American Heart of Poland, 43-100 Tychy, Poland
| | - Dariusz A. Kosior
- Mossakowski Medical Research Centre Polish Academy of Sciences, 02-106 Warsaw, Poland
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Fujimoto W, Odajima S, Okamoto H, Iwasaki M, Nagao M, Konishi A, Shinohara M, Toh R, Okuda M, Hirata KI, Tanaka H. Importance of B-Type Natriuretic Peptide in the Detection of Patients With Structural Heart Disease in a Primary Care Setting. Circ J 2024; 88:732-739. [PMID: 38369348 DOI: 10.1253/circj.cj-23-0930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Early detection and intervention for preclinical heart failure (HF) are crucial for restraining the potential increase in patients with HF. Thus, we designed and conducted a single-center retrospective cohort study to confirm the efficacy of B-type natriuretic peptide (BNP) for the early detection of preclinical HF in a primary care setting.Methods and Results: We investigated 477 patients with no prior diagnosis of HF who were under the care of general practitioners. These patients were categorized into 4 groups based on BNP concentrations: Category 1, 0 pg/mL≤BNP≤35 pg/mL; Category 2, 35 pg/mL200 pg/mL. There was a marked and statistically significant increase in the prevalence of preclinical HF with increasing BNP categories: 19.9%, 57.9%, 87.5%, and 96.0% in Categories 1, 2, 3, and 4, respectively. Compared with Category 1, the odds ratio of preclinical HF in Categories 2, 3, and 4 was determined to be 5.56 (95% confidence interval [CI] 3.57-8.67), 23.70 (95% CI 8.91-63.11), and 171.77 (95% CI 10.31-2,861.93), respectively. CONCLUSIONS Measuring BNP is a valuable tool for the early detection of preclinical HF in primary care settings. Proactive testing in patients at high risk of HF could play a crucial role in addressing the impending HF pandemic.
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Affiliation(s)
- Wataru Fujimoto
- Division of Cardiovascular Medicine, Hyogo Prefectural Awaji Medical Center
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Susumu Odajima
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | | | - Masamichi Iwasaki
- Division of Cardiovascular Medicine, Hyogo Prefectural Awaji Medical Center
| | - Manabu Nagao
- Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine
| | - Akihide Konishi
- Clinical and Translational Research Center, Kobe University Hospital
| | - Masakazu Shinohara
- Division of Molecular Epidemiology, Kobe University Graduate School of Medicine
| | - Ryuji Toh
- Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine
| | - Masanori Okuda
- Division of Cardiovascular Medicine, Hyogo Prefectural Awaji Medical Center
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Kinoshita M, Saito M, Inoue K, Tasaka T, Nakagawa H, Fujimoto K, Sato S, Nishimura K, Ikeda S, Sumimoto T, Yamaguchi O. Incremental value of tricuspid annular enlargement to progressive tricuspid regurgitation in patients with longstanding persistent atrial fibrillation. Heart Vessels 2024:10.1007/s00380-024-02405-6. [PMID: 38635061 DOI: 10.1007/s00380-024-02405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
Tricuspid annular enlargement in patients with atrial fibrillation (AF) can induce tricuspid regurgitation (TR). However, risk factors associated with TR progression in patients with AF have not been defined. This study aimed to clarify an association between tricuspid annular diameter (TAD) and TR progression in patients with longstanding persistent AF. We retrospectively analyzed data from 228 patients who had longstanding persistent AF for > 1 year and mild or less TR on baseline echocardiograms. We defined significant TR as moderate or greater TR, graded according to the jet area and vena contracta. The optimal cut-off value of the TAD index (TADI), based on body surface area for predicting progression to significant TR, was estimated using receiver operating characteristic (ROC) curves. The independence and incremental value of the TADI were evaluated using multivariate Cox proportional hazard regression analysis and likelihood ratio tests. Over a median follow-up of 3.7 years, 55 (24.1%) patients developed significant TR. The optimal cut-off value of 21.1 mm/m2 for the TADI at baseline and ROC curves predicted TR progression with 70.4% sensitivity and 86% specificity. Furthermore, TADI was an independent predictor of TR progression (hazard ratio, 1.32; 95% confidence interval, 1.17-1.49, P < 0.001) and had a significant incremental value that exceeded that of models constructed using clinical parameters. In conclusion, TADI was significantly associated with TR progression and was an independent predictor of TR progression in longstanding persistent AF.
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Affiliation(s)
- Masaki Kinoshita
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, 795-8505, Japan.
| | - Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, 795-8505, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Tatsuro Tasaka
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, 795-8505, Japan
| | - Hirohiko Nakagawa
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, 795-8505, Japan
| | - Kaori Fujimoto
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, 795-8505, Japan
| | - Sumiko Sato
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, 795-8505, Japan
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Takumi Sumimoto
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, 795-8505, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
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Soh MS, Jang JH, Park JS, Shin JH. Effects of high-gravity acceleration forces and anti-gravity maneuver on the cardiac function of fighter pilots. Sci Rep 2024; 14:8749. [PMID: 38627423 PMCID: PMC11021439 DOI: 10.1038/s41598-024-59274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
The fighter pilots exposed to high gravitational (G) acceleration must perform anti-G maneuvers similar to the Valsalva maneuver. However, the effects of high-G acceleration and anti-G maneuvers on cardiac function have rarely been studied. This study aimed to investigate the effects of high-G forces on cardiac function of fighter pilots. Fighter pilots who underwent regular health check-ups and echocardiography were included (n = 29; 100% men, 41 ± 10 years old; mean flight time, 1821 ± 1186 h). Trainees who had not experienced any flights were included in the control group (n = 16; 100% men, 36 ± 17 years old). Echocardiographic data included left ventricular chamber size, systolic and diastolic functions, right ventricular systolic pressure (RVSP), inferior vena cava (IVC) collapsibility, and tricuspid annular plane systolic excursion (TAPSE). No significant differences in left ventricular ejection fraction, RVSP, or IVC collapsibility were observed between two groups. In the multivariate linear regression analysis with total flight time as an independent continuous variable for fighter pilots, TAPSE was positively correlated with total flight time. The experience of fighter pilots who were exposed to high-G acceleration forces and anti-G maneuvers did not cause cardiac structural changes, but the exposure might be associated with right heart function changes.
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Affiliation(s)
- Moon-Seung Soh
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Division of Cardiology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
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Porcari A, Fontana M, Canepa M, Biagini E, Cappelli F, Gagliardi C, Longhi S, Pagura L, Tini G, Dore F, Bonfiglioli R, Bauckneht M, Miceli A, Girardi F, Martini AL, Barbati G, Costanzo EN, Caponetti AG, Paccagnella A, Sguazzotti M, La Malfa G, Zampieri M, Sciagrà R, Perfetto F, Rowczenio D, Gilbertson J, Hutt DF, Hawkins PN, Rapezzi C, Merlo M, Sinagra G, Gillmore JD. Clinical and Prognostic Implications of Right Ventricular Uptake on Bone Scintigraphy in Transthyretin Amyloid Cardiomyopathy. Circulation 2024; 149:1157-1168. [PMID: 38328945 PMCID: PMC11000629 DOI: 10.1161/circulationaha.123.066524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The extent of myocardial bone tracer uptake with technetium pyrophosphate, hydroxymethylene diphosphonate, and 3,3-diphosphono-1,2-propanodicarboxylate in transthyretin amyloid cardiomyopathy (ATTR-CM) might reflect cardiac amyloid burden and be associated with outcome. METHODS Consecutive patients with ATTR-CM who underwent diagnostic bone tracer scintigraphy with acquisition of whole-body planar and cardiac single-photon emission computed tomography (SPECT) images from the National Amyloidosis Centre and 4 Italian centers were included. Cardiac uptake was defined according to the Perugini classification: 0=absent cardiac uptake; 1=mild uptake less than bone; 2=moderate uptake equal to bone; and 3=high uptake greater than bone. Extent of right ventricular (RV) uptake was defined as focal (basal segment of the RV free wall only) or diffuse (extending beyond basal segment) on the basis of SPECT imaging. The primary outcome was all-cause mortality. RESULTS Among 1422 patients with ATTR-CM, RV uptake accompanying left ventricular uptake was identified by SPECT imaging in 100% of cases at diagnosis. Median follow-up in the whole cohort was 34 months (interquartile range, 21 to 50 months), and 494 patients died. By Kaplan-Meier analysis, diffuse RV uptake on SPECT imaging (n=936) was associated with higher all-cause mortality compared with focal (n=486) RV uptake (77.9% versus 22.1%; P<0.001), whereas Perugini grade was not associated with survival (P=0.27 in grade 2 versus grade 3). On multivariable analysis, after adjustment for age at diagnosis (hazard ratio [HR], 1.03 [95% CI, 1.02-1.04]; P<0.001), presence of the p.(V142I) TTR variant (HR, 1.42 [95% CI, 1.20-1.81]; P=0.004), National Amyloidosis Centre stage (each category, P<0.001), stroke volume index (HR, 0.99 [95% CI, 0.97-0.99]; P=0.043), E/e' (HR, 1.02 [95% CI, 1.007-1.03]; P=0.004), right atrial area index (HR, 1.05 [95% CI, 1.02-1.08]; P=0.001), and left ventricular global longitudinal strain (HR, 1.06 [95% CI, 1.03-1.09]; P<0.001), diffuse RV uptake on SPECT imaging (HR, 1.60 [95% CI, 1.26-2.04]; P<0.001) remained an independent predictor of all-cause mortality. The prognostic value of diffuse RV uptake was maintained across each National Amyloidosis Centre stage and in both wild-type and hereditary ATTR-CM (P<0.001 and P=0.02, respectively). CONCLUSIONS Diffuse RV uptake of bone tracer on SPECT imaging is associated with poor outcomes in patients with ATTR-CM and is an independent prognostic marker at diagnosis.
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Affiliation(s)
- Aldostefano Porcari
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (A.P., L.P., M.M., G.S.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (A.P., L.P., M.M., G.S.)
| | - Marco Canepa
- Cardiovascular Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy (M.C., G.L.M.)
- Department of Internal Medicine, University of Genova, Italy (M.C.)
| | - Elena Biagini
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (E.B., C.G., S.L.)
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy (F.C., F.P.)
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Italy (F.C., M.Z.)
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (F.D., F.G.)
| | - Christian Gagliardi
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (E.B., C.G., S.L.)
| | - Simone Longhi
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (E.B., C.G., S.L.)
| | - Linda Pagura
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (A.P., L.P., M.M., G.S.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
| | - Giacomo Tini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliera Universitaria Sant’Andrea, Italy (G.T.)
| | - Franca Dore
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (F.D., F.G.)
| | - Rachele Bonfiglioli
- Department of Nuclear Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Italy (R.B., A.P.)
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy (M.B.)
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genova, Italy (M.B.)
| | - Alberto Miceli
- Nuclear Medicine Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (A.M.)
| | - Francesca Girardi
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (F.D., F.G.)
| | - Anna Lisa Martini
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” University of Florence, Careggi University Hospital, Italy (A.L.M., E.N.C., R.S.)
| | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Italy (G.B.)
| | - Egidio Natalino Costanzo
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” University of Florence, Careggi University Hospital, Italy (A.L.M., E.N.C., R.S.)
| | - Angelo Giuseppe Caponetti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy (A.G.C., M.S.)
| | - Andrea Paccagnella
- Department of Nuclear Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Italy (R.B., A.P.)
| | - Maurizio Sguazzotti
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy (A.G.C., M.S.)
| | - Giovanni La Malfa
- Cardiovascular Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy (M.C., G.L.M.)
| | - Mattia Zampieri
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Italy (F.C., M.Z.)
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” University of Florence, Careggi University Hospital, Italy (A.L.M., E.N.C., R.S.)
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy (F.C., F.P.)
| | - Dorota Rowczenio
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
| | - Janet Gilbertson
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
| | - David F. Hutt
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
| | - Philip N. Hawkins
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
| | - Claudio Rapezzi
- Cardiothoracic Department, University of Ferrara, Italy (C.R.)
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy (C.R.)
| | - Marco Merlo
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
| | - Gianfranco Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (A.P., L.P., M.M., G.S.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
| | - Julian D. Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
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Bjerring AW, Smeland KH, Stokke T, Haugaa KH, Holte E, Rösner A, Kiserud CE, Edvardsen T, Sarvari SI. Long-term cardiac effects of modern treatment for Hodgkin's lymphoma. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:19. [PMID: 38576044 PMCID: PMC10993441 DOI: 10.1186/s40959-024-00222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Hodgkin's lymphoma (HL) is a hematological malignancy that affects both children and young adults. Traditional treatment is associated with a life-time prevalence of cardiac disease exceeding 50%. In the late 1990s protocols were modified to reduce cancer therapy-related adverse cardiac effects. This study aimed to assess the long-term impact of advances in treatment protocols on the cardiac health of HL survivors (HLS). METHODS HLS (n = 246) treated between 1997 and 2007 with anthracycline-based chemotherapy in three centers in Norway were included. Of these, 132 (53%) had also received mediastinal radiotherapy. HLS were compared to controls (n = 58) recruited from the general population and matched for sex, age, smoking status, and heredity for coronary artery disease. All subjects underwent echocardiography, clinical assessment, and blood sampling. RESULTS The HLS were 46 ± 9 years old and had been treated 17 ± 3 years before inclusion in the study. There was no significant difference between HLS and controls in ejection fraction (EF) (58%±5 vs. 59%±4, p = 0.08) or prevalence of heart failure. HLS treated with both anthracyclines and mediastinal radiotherapy (AC + MRT) had slightly worse left ventricular global longitudinal strain than controls (-19.3 ± 2.5% vs. -20.8 ± 2.0%, p < 0.001), but those treated with only anthracyclines did not. HLS treated with AC + MRT had a higher prevalence of valve disease than those treated only with anthracyclines (12% vs. 4%, p < 0.05). CONCLUSIONS HLS treated with anthracyclines after the late 1990s have similar cardiac function and morphology as age-matched controls, apart from higher rates of valvular disease in those who also underwent mediastinal radiotherapy.
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Affiliation(s)
- Anders W Bjerring
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Hb Smeland
- National advisory unit for late effects after cancer, Department of Oncology, Oslo University hospital, Oslo, Norway
| | - Thomas Stokke
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen Holte
- Department of Circulation and Medical Imaging, Clinic of Cardiology, St. Olavs University Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Assami Rösner
- Cardiological Department, University Hospital North Norway, Tromsø, Norway
- Institute of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Cecilie E Kiserud
- National advisory unit for late effects after cancer, Department of Oncology, Oslo University hospital, Oslo, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sebastian Imre Sarvari
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
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Grandperrin A, Ollive P, Kretel Y, Maufrais C, Nottin S. Impact of a 16-week strength training program on physical performance, body composition and cardiac remodeling in previously untrained women and men. Eur J Sport Sci 2024; 24:474-486. [PMID: 38895874 PMCID: PMC11170668 DOI: 10.1002/ejsc.12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/09/2023] [Accepted: 08/22/2023] [Indexed: 06/21/2024]
Abstract
Even if more and more women are involved in strength-training (ST) programs in fitness centers, studies on strength gain, body composition, and cardiac remodeling were mainly conducted in men and whether they are similar in women remains to be explored. In this context, the aim of our study was to assess the effect of a supervised ST program on strength gains, body composition, and cardiac remodeling in previously untrained women and men. 17 healthy and previously untrained young women and 17 young men participated in a supervised 16-week ST program built according to the recommendation of the American College of Sports Medicine in terms of intensity, and strictly using similar volume and intensity in both groups. Strength performance, body composition, and cardiac remodeling were evaluated every 4 weeks. Cardiac adaptations were assessed using resting echocardiography, including regional 2D-Strain analysis of the left atrium and ventricle (LA and LV, respectively). Despite lower values at baseline, women exhibited similar or even higher strength gains compared to men. ST induced a decrease of body and abdominal fat mass and an increase of lean body mass in both groups. Similar cardiac remodeling was observed in women, and women, including an early and progressive LV and LA enlargement throughout the ST program, without any alteration of LV diastolic and systolic functions. These findings underlie that ST programs are highly suitable for women to enhance their strength performance and their cardiovascular health.
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Miger K, Overgaard Olesen AS, Grand J, Fabricius-Bjerre A, Sajadieh A, Høst N, Køber N, Abild A, Pedersen L, Lawaetz Schultz HH, Torp-Pedersen C, Ploug Boesen M, Thune JJ, Nielsen OW. Computed tomography or chest X-ray to assess pulmonary congestion in dyspnoeic patients with acute heart failure. ESC Heart Fail 2024; 11:1163-1173. [PMID: 38279517 DOI: 10.1002/ehf2.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024] Open
Abstract
AIMS While computed tomography (CT) is widely acknowledged as superior to chest radiographs for acute diagnostics, its efficacy in diagnosing acute heart failure (AHF) remains unexplored. This prospective study included consecutive patients with dyspnoea undergoing simultaneous low-dose chest CT (LDCT) and chest radiographs. Here, we aimed to determine if LDCT is superior to chest radiographs to confirm pulmonary congestion in dyspnoeic patients with suspected AHF. METHODS AND RESULTS An observational, prospective study, including dyspnoeic patients from the emergency department. All patients underwent concurrent clinical examination, laboratory tests, echocardiogram, chest radiographs, and LDCT. The primary efficacy measure to compare the two radiological methods was conditional odds ratio (cOR). The primary outcome was adjudicated AHF, ascertained by comprehensive expert consensus. The secondary outcome, echo-bnp AHF, was an objective AHF diagnosis based on echocardiographic cardiac dysfunction, elevated cardiac filling pressure, loop diuretic administration, and NT-pro brain natriuretic peptide > 300 pg/mL. Of 228 dyspnoeic patients, 64 patients (28%) had adjudicated AHF, and 79 patients (35%) had echo-bnp AHF. Patients with AHF were older (78 years vs. 73 years), had lower left ventricular ejection fraction (36% vs. 55%), had higher elevated left ventricular filling pressures (98% vs. 18%), and had higher NT-pro brain natriuretic peptide levels (3628 pg/mL vs. 470 pg/mL). The odds to diagnose adjudicated AHF and echo-bnp AHF were up to four times greater using LDCT (cOR: 3.89 [2.15, 7.06] and cOR: 2.52 [1.45, 4.38], respectively). For each radiologic sign of pulmonary congestion, the LDCT provided superior or equivalent results as the chest radiographs, and the interrater agreement was higher using LDCT (kappa 0.88 [95% CI: 0.81, 0.95] vs. 0.73 [95% CI: 0.63, 0.82]). As first-line imaging modality, LDCT will find one additional adjudicated AHF in 12.5 patients and prevent one false-positive in 20 patients. Similar results were demonstrated for echo-bnp AHF. CONCLUSIONS In consecutive dyspnoeic patients admitted to the emergency department, LDCT is significantly better than chest radiographs in detecting pulmonary congestion.
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Affiliation(s)
- Kristina Miger
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sophie Overgaard Olesen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Johannes Grand
- Department of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Andreas Fabricius-Bjerre
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Nanna Køber
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Annemette Abild
- Department of Radiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Pedersen
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Hans Henrik Lawaetz Schultz
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Cardiology, Aalborg University Hospital, North Denmark Region, Denmark
| | - Mikael Ploug Boesen
- Department of Radiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Olav W Nielsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Song HJ, Kim HY, Park S, Lee SH. Factors influencing self-care behaviour in patients with heart failure: Grit as a behavioural support factor. Int J Nurs Pract 2024; 30:e13151. [PMID: 36945789 DOI: 10.1111/ijn.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 02/16/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
AIMS This study aimed to examine the relationship between heart failure knowledge, self-efficacy, social support, grit and self-care behaviour in patients with heart failure and to identify factors associated with patients' self-care behaviour. BACKGROUND Most patients with heart failure are not as active in implementing self-care behavioural practices as recommended by the guidelines. DESIGN This descriptive cross-sectional study was designed based on Bandura's Social Cognitive Theory. METHODS This study included 138 patients who were diagnosed with heart failure in an outpatient department of cardiology at a tertiary hospital in Korea. Data were collected between July and October 2020 using a structured questionnaire and electronic medical records. Data were analysed using the SPSS/WIN 27.0 program. RESULTS Grit had the strongest association with self-care behaviour among patients with heart failure, followed by social support, self-efficacy and heart failure knowledge. These variables accounted for approximately 52% of the variance in self-care behaviour. CONCLUSIONS Health-care professionals should assess patients' grit and develop patient-tailored grit enhancement programmes. Based on the social cognitive theory, nursing intervention programmes that can simultaneously manage cognitive (knowledge and self-efficacy), social and environmental (social support) and behavioural support (grit) factors should be developed and applied to nursing practices to promote self-care.
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Affiliation(s)
- Hyun Jin Song
- Department of Nursing, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hye Young Kim
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Republic of Korea
| | - Sookkyoung Park
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Republic of Korea
| | - Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Chen X, Shui X, Xu H, Peng J, Deng H, Zhong J, Wang C, Wu J, Yan J, Yao B, Xiong Z, Xu W, Yang X. Sudomotor dysfunction is associated with impaired left ventricular diastolic function in persons with type 2 diabetes: a cross-sectional study. J Endocrinol Invest 2024; 47:973-982. [PMID: 37999892 DOI: 10.1007/s40618-023-02214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/26/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The incidence of preserved ejection fraction heart failure has significantly increased in persons with type 2 diabetes mellitus (T2DM). Left ventricular (LV) diastolic dysfunction is an early and important manifestation of preserved ejection fraction heart failure. The onset of heart failure in persons with diabetes is associated with diabetic neuropathy. However, the relationship among sudomotor function, which is an early manifestation of small fiber neuropathy, and LV diastolic function remains unclear. This study aimed to explore the association between sudomotor function and LV diastolic function in persons with T2DM. METHODS In total, 699 persons with T2DM were enrolled and divided into three groups according to electrochemical skin conductance (ESC) assessed using the SUDOSCAN device: "no dysfunction" group (NSF), "moderate dysfunction" group (MDF), and "severe dysfunction" group (SDF). LV diastolic function was assessed using Doppler echocardiography. To evaluate the relationship between ESC and echocardiographic parameters, Pearson's correlation analysis was performed. Additionally, logistic regression analysis was used to determine the association between LV diastolic function and ESC. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of sudomotor function indicators in detecting impaired cardiac diastolic function. RESULTS There were 301 persons (43.06%) in the NSF group, 232 (33.19%) in the MDF group, and 166 (23.75%) in the SDF group. Compared to the NSF group, the MDF and SDF groups had higher A and E/e' and lower e' values (all p < 0.05). Pearson's correlation analysis showed that A and E/e' were negatively associated with foot ESC (FESC) and hand ESC (HESC), whereas e' was positively associated with FESC and HESC (all p < 0.05). After adjusting for confounding factors, binary logistic regression analysis showed that ESC was independently associated with impaired LV diastolic function (p = 0.003). The area under the ROC curve values for FESC and HESC were 0.621 and 0.635, respectively (both p < 0.05). CONCLUSIONS Deteriorating sudomotor function was associated with reduced diastolic function indicators. ESC can be used as a biomarker for detecting LV diastolic impairment.
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Affiliation(s)
- X Chen
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - X Shui
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - H Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - J Peng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - H Deng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - J Zhong
- Department of Ultrasonography, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - C Wang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - J Wu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - J Yan
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - B Yao
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - Z Xiong
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China.
| | - W Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China.
| | - X Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China.
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Gudigar A, Kadri NA, Raghavendra U, Samanth J, Maithri M, Inamdar MA, Prabhu MA, Hegde A, Salvi M, Yeong CH, Barua PD, Molinari F, Acharya UR. Automatic identification of hypertension and assessment of its secondary effects using artificial intelligence: A systematic review (2013-2023). Comput Biol Med 2024; 172:108207. [PMID: 38489986 DOI: 10.1016/j.compbiomed.2024.108207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
Artificial Intelligence (AI) techniques are increasingly used in computer-aided diagnostic tools in medicine. These techniques can also help to identify Hypertension (HTN) in its early stage, as it is a global health issue. Automated HTN detection uses socio-demographic, clinical data, and physiological signals. Additionally, signs of secondary HTN can also be identified using various imaging modalities. This systematic review examines related work on automated HTN detection. We identify datasets, techniques, and classifiers used to develop AI models from clinical data, physiological signals, and fused data (a combination of both). Image-based models for assessing secondary HTN are also reviewed. The majority of the studies have primarily utilized single-modality approaches, such as biological signals (e.g., electrocardiography, photoplethysmography), and medical imaging (e.g., magnetic resonance angiography, ultrasound). Surprisingly, only a small portion of the studies (22 out of 122) utilized a multi-modal fusion approach combining data from different sources. Even fewer investigated integrating clinical data, physiological signals, and medical imaging to understand the intricate relationships between these factors. Future research directions are discussed that could build better healthcare systems for early HTN detection through more integrated modeling of multi-modal data sources.
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Affiliation(s)
- Anjan Gudigar
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Nahrizul Adib Kadri
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - U Raghavendra
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104, India.
| | - Jyothi Samanth
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India
| | - M Maithri
- Department of Mechatronics, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Mahesh Anil Inamdar
- Department of Mechatronics, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Mukund A Prabhu
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Ajay Hegde
- Manipal Hospitals, Bengaluru, Karnataka, 560102, India
| | - Massimo Salvi
- Biolab, PolitoBIOMedLab, Department of Electronics and Telecommunications, Politecnicodi Torino, Turin, Italy
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500, Subang Jaya, Malaysia
| | - Prabal Datta Barua
- Cogninet Brain Team, Cogninet Australia, Sydney, NSW, 2010, Australia; School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Toowoomba, QLD, 4350, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Filippo Molinari
- Biolab, PolitoBIOMedLab, Department of Electronics and Telecommunications, Politecnicodi Torino, Turin, Italy
| | - U Rajendra Acharya
- School of Mathematics, Physics, and Computing, University of Southern Queensland, Springfield, QLD, 4300, Australia; Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
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Scott JM, Lee J, Michalski MG, Batch K, Simpson AL, Peoples J, Lee CP, Harrison JN, Yu AF, Sasso JP, Dang C, Moskowitz CS, Jones LW, Eves ND. Mechanisms of Exercise Intolerance Across the Breast Cancer Continuum: A Pooled Analysis of Individual Patient Data. Med Sci Sports Exerc 2024; 56:590-599. [PMID: 38485730 PMCID: PMC10948020 DOI: 10.1249/mss.0000000000003348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
PURPOSE The purpose of this study is to evaluate the prevalence of abnormal cardiopulmonary responses to exercise and pathophysiological mechanism(s) underpinning exercise intolerance across the continuum of breast cancer (BC) care from diagnosis to metastatic disease. METHODS Individual participant data from four randomized trials spanning the BC continuum ([1] prechemotherapy [n = 146], [2] immediately postchemotherapy [n = 48], [3] survivorship [n = 138], and [4] metastatic [n = 47]) were pooled and compared with women at high-risk of BC (BC risk; n = 64). Identical treadmill-based peak cardiopulmonary exercise testing protocols evaluated exercise intolerance (peak oxygen consumption; V̇O2peak) and other resting, submaximal, and peak cardiopulmonary responses. The prevalence of 12 abnormal exercise responses was evaluated. Graphical plots of exercise responses were used to identify oxygen delivery and/or uptake mechanisms contributing to exercise intolerance. Unsupervised, hierarchical cluster analysis was conducted to explore exercise response phenogroups. RESULTS Mean V̇O2peak was 2.78 ml O2.kg-1·min-1 (95% confidence interval [CI], -3.94, -1.62 mL O2.kg-1·min-1; P < 0.001) lower in the pooled BC cohort (52 ± 11 yr) than BC risk (55 ± 10 yr). Compared with BC risk, the pooled BC cohort had a 2.5-fold increased risk of any abnormal cardiopulmonary response (odds ratio, 2.5; 95% confidence interval, 1.2, 5.3; P = 0.014). Distinct exercise responses in BC reflected impaired oxygen delivery and uptake relative to control, although considerable inter-individual heterogeneity within cohorts was observed. In unsupervised, hierarchical cluster analysis, six phenogroups were identified with marked differences in cardiopulmonary response patterns and unique clinical characteristics. CONCLUSIONS Abnormal cardiopulmonary response to exercise is common in BC and is related to impairments in oxygen delivery and uptake. The identification of exercise response phenogroups could help improve cardiovascular risk stratification and guide investigation of targeted exercise interventions.
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Affiliation(s)
- Jessica M. Scott
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Jasme Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | - Anthony F. Yu
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Chau Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Chaya S. Moskowitz
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Lee W. Jones
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Neil D. Eves
- University of British Columbia, Kelowna, BC, CANADA
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Petramala L, Gigante A, Sarlo F, Servello A, Circosta F, Marino L, Ciccarelli A, Cavallaro G, Letizia C. Relevance of obesity-related organ damage and metabolic syndrome classification in cardiovascular and renal risk stratification in patients with essential hypertension. Front Cardiovasc Med 2024; 11:1369090. [PMID: 38606379 PMCID: PMC11008466 DOI: 10.3389/fcvm.2024.1369090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Hypertension is a relevant cardiovascular comorbidity. Adipose tissue represents a metabolically active tissue involved in the regulation of blood pressure and metabolic alterations. In recent decades, several classifications for the metabolic syndrome (MS) have been proposed. Recently, a new syndrome called the "Cardiovascular-kidney-metabolic" (CKM) syndrome was identified, to determine patients at high cardiovascular and metabolic risk. The aim of the study was to compare different classifications in a large population of hypertensive patients. Materials and methods Between September 2022 and August 2023, we consecutively enrolled 772 hypertensive patients (407 men; 365 women; mean age 52.2 ± 15.1 years), evaluating anthropometric, biochemical, and instrumental parameters (transthoracic echocardiogram, carotid echo-Doppler, 24-h ambulatory blood pressure monitoring, fundus oculi). Results Using different classifications we found MS prevalence: Adult Treatment Panel III (ATP-III) 28.8%, International Diabetes Federation (IDF) 31.5%, CKM 40.7%. CKM Classes 3 and 4 showed higher body mass index and waist circumference compared with other groups. Compared with ATP-III and IDF, CKM Class 4 showed higher 24-h systolic blood pressure, lower percentage of controlled hypertension, increased interventricular septum and posterior wall, reduced ejection fraction, and greater prevalence of hypertensive arterial retinal damage. Discussion Visceral obesity and MS are frequent conditions with healthy impact, becoming an important trigger for the development of cardiovascular and metabolic complications. The different MS classifications allow the early identification of patients at high risk of cardiometabolic complications. The new CKM syndrome proves useful to identify individuals at high risk for CKM morbidity and mortality.
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Affiliation(s)
- Luigi Petramala
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Francesca Sarlo
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli I.R.C.C.S., Rome, Italy
| | - Adriana Servello
- Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, Policlinico “Umberto I”, Rome, Italy
| | - Francesco Circosta
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Luca Marino
- Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, Policlinico “Umberto I”, Rome, Italy
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Rome, Italy
| | - Antonello Ciccarelli
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Rome, Italy
- General Surgery Unit, ICOT Hospital, Latina, Italy
| | - Claudio Letizia
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Rome, Italy
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Moraru L, Mirea O, Toader D, Berceanu M, Soldea S, Munteanu A, Donoiu I, Raicea V. Lower Limit of Normality of Segmental Multilayer Longitudinal Strain in Healthy Adult Subjects. J Cardiovasc Dev Dis 2024; 11:102. [PMID: 38667720 PMCID: PMC11050488 DOI: 10.3390/jcdd11040102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Speckle tracking echocardiography is an advanced imaging technique that allows for a more detailed assessment of cardiac global and regional function. Reference values for segmental longitudinal layered strain (subendocardial, mid-myocardial, and subepicardial) are scarce, limiting the clinical use of these measurements in clinical practice. Two hundred consecutive Caucasian healthy subjects (mean age = 37 ± 11 years) were enrolled in the study. The mean values of global longitudinal strain (GLS) for endocardial (Endo), mid-myocardial (Myo) and epicardial (Epi) layers were -22.9 ± 2.7, -20.0 ± 2.4 and -17.5 ± 2.1, respectively. The GLSEndo/GLSMyo ratio was 1.1 ± 0.05, while the GLSEndo/GLSEpi ratio was 1.3 ± 0.05. The apical strain-sparing ratio was >1 in 10% of the subjects (endocardium) and 7% (mid-myocardium). The lower limits for segmental LS were as follows: for endocardial LS, -10% (basal), -12% (mid), -14% (apical); for mid-myocardial LS, -10% -10% (basal), -10% (mid), -10% (apical); and for epicardial LS, -7% (basal), -8% (mid), -8% (apical). The findings of this study provide data regarding the lower limit of normality of LS for each LV segment and suggest, for practical considerations, that an LS value below 10% should be considered abnormal in any segment. Further larger studies are warranted to confirm these findings.
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Affiliation(s)
- Liviu Moraru
- Department of Anatomy, UMFST, 540142 Targu-Mures, Romania;
- Department of CardioVascular Surgery, IUBCVT, 540142 Targu-Mures, Romania
| | - Oana Mirea
- Department of Cardiology, Emergency County Hospital Craiova, 200638 Craiova, Romania; (D.T.); (S.S.); (I.D.)
| | - Despina Toader
- Department of Cardiology, Emergency County Hospital Craiova, 200638 Craiova, Romania; (D.T.); (S.S.); (I.D.)
| | - Mihaela Berceanu
- Department of CardioVascular Surgery, Emergency County Hospital Craiova, 200638 Craiova, Romania; (M.B.); (V.R.)
| | - Sorina Soldea
- Department of Cardiology, Emergency County Hospital Craiova, 200638 Craiova, Romania; (D.T.); (S.S.); (I.D.)
| | - Alexandru Munteanu
- Department of General Surgery, Emergency County Hospital Craiova, 200638 Craiova, Romania;
| | - Ionuț Donoiu
- Department of Cardiology, Emergency County Hospital Craiova, 200638 Craiova, Romania; (D.T.); (S.S.); (I.D.)
| | - Victor Raicea
- Department of CardioVascular Surgery, Emergency County Hospital Craiova, 200638 Craiova, Romania; (M.B.); (V.R.)
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48
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Mandoli GE, Cameli M, Pastore MC, Loiacono F, Righini FM, D'Ascenzi F, Focardi M, Cavigli L, Lisi M, Bisleri G, Dokollari A, Bernazzali S, Maccherini M, Valente S, Henein MY. Left ventricular fibrosis as a main determinant of filling pressures and left atrial function in advanced heart failure. Eur Heart J Cardiovasc Imaging 2024; 25:446-453. [PMID: 38109280 DOI: 10.1093/ehjci/jead340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
AIMS Advanced heart failure (AdHF) is characterized by variable degrees of left ventricular (LV) dysfunction, myocardial fibrosis, and raised filling pressures which lead to left atrial (LA) dilatation and cavity dysfunction. This study investigated the relationship between LA peak atrial longitudinal strain (PALS), assessed by speckle-tracking echocardiography (STE), and invasive measures of LV filling pressures and fibrosis in a group of AdHF patients undergoing heart transplantation (HTX). METHODS AND RESULTS We consecutively enrolled patients with AdHF who underwent HTX at our Department. Demographic and basic echocardiographic data were registered, then invasive intracardiac pressures were obtained from right heart catheterization, and STE was also performed. After HTX, biopsy specimens from explanted hearts were collected to quantify the degree of LV myocardial fibrosis. Sixty-four patients were included in the study (mean age 62.5 ± 11 years, 42% female). The mean LV ejection fraction (LVEF) was 26.7 ± 6.1%, global PALS was 9.65 ± 4.5%, and mean pulmonary capillary wedge pressure (PCWP) was 18.8 ± 4.8 mmHg. Seventy-three % of patients proved to have severe LV fibrosis. Global PALS was inversely correlated with PCWP (R = -0.83; P < 0.0001) and with LV fibrosis severity (R = -0.78; P < 0.0001) but did not correlate with LVEF (R = 0.15; P = 0.2). Among echocardiographic indices of LV filling pressures, global PALS proved the strongest [area under the curve 0.955 (95% confidence interval 0.87-0.99)] predictor of raised (>18 mmHg) PCWP. CONCLUSION In patients with AdHF, reduced global PALS strongly correlated with the invasively assessed LV filling pressure and degree of LV fibrosis. Such relationship could be used as non-invasive indicator for optimum patient stratification for therapeutic strategies.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Ferdinando Loiacono
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Francesca Maria Righini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Matteo Lisi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
- Division of Cardiology, Department of Cardiovascular Diseases-AUSL Romagna, 'Santa Maria delle Croci' Hospital, Ravenna, Italy
| | | | | | - Sonia Bernazzali
- Department of Cardiac Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimo Maccherini
- Department of Cardiac Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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49
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Schwegel N, Zach D, Peikert A, Santner V, Höller V, Gollmer J, Späth J, Riepl H, Rainer PP, Wallner M, Pilz S, Zirlik A, von Lewinski D, Ablasser K, Verheyen N, Kolesnik E. The Prognostic Value of Right Ventricular Function in Patients with Chronic Heart Failure-A Prospective Study. J Clin Med 2024; 13:1930. [PMID: 38610695 PMCID: PMC11012981 DOI: 10.3390/jcm13071930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: In patients with stable chronic heart failure with a reduced ejection fraction (HFrEF), left ventricular ejection fraction (LVEF) provides limited prognostic value, especially in patients with moderately to severely reduced LVEF. Echocardiographic parameters of right ventricular function may be associated with adverse clinical events in these patients. Therefore, we analyzed 164 patients with HFrEF in a prospective single-center cohort study to evaluate whether the parameters of right ventricular function are associated with worsening heart failure (WHF) hospitalizations, cardiovascular and all-cause deaths and combined endpoints. Methods: Echocardiographic cine loops were analyzed using vendor-independent post-processing software. Multivariate Cox regression analyses were performed, which were then adjusted for clinical characteristics and left ventricular functional parameters. Results: In these models, higher tricuspid annular plane systolic excursion (TAPSE) was significantly associated with lower rates of WHF hospitalizations (HR 0.880, 95%CI 0.800-0.968, p = 0.008), a composite endpoint of WHF hospitalizations and cardiovascular death (HR 0.878, 95%CI 0.800-0.964, p = 0.006), and a composite endpoint of WHF hospitalization and all-cause death (HR 0.918, 95%CI 0.853-0.988, p = 0.023). These associations were more pronounced in patients with LVEF ≤ 35%. Conclusions: In conclusion, in patients with HFrEF, TAPSE is an independent prognosticator for adverse clinical outcomes, warranting further studies to elucidate whether incorporating TAPSE into established risk scores improves their diagnostic accuracy.
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Affiliation(s)
- Nora Schwegel
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - David Zach
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Alexander Peikert
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Viktoria Santner
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Viktoria Höller
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Johannes Gollmer
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Johannes Späth
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Hermann Riepl
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Peter P. Rainer
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
- Department of Medicine, St. Johann in Tirol General Hospital, 6380 St. Johann in Tirol, Austria
- BioTechMed Graz, 8010 Graz, Austria
| | - Markus Wallner
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Andreas Zirlik
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Klemens Ablasser
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Nicolas Verheyen
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
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50
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Lindow T, Manouras A, Lindqvist P, Manna D, Wieslander B, Kozor R, Strange G, Playford D, Ugander M. Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading. Eur Heart J Cardiovasc Imaging 2024; 25:498-509. [PMID: 37949842 DOI: 10.1093/ehjci/jead301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Grading of diastolic function can be useful, but indeterminate classifications are common. We aimed to invasively derive and validate a quantitative echocardiographic estimation of pulmonary artery wedge pressure (PAWP) and to compare its prognostic performance to diastolic dysfunction grading. METHODS AND RESULTS Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analysed in the National Echocardiography Database of Australia (NEDA). In patients who had undergone both RHC and echocardiography within 2 h (n = 90), ePAWP was derived using left atrial volume index, mitral peak early velocity (E), and pulmonary vein systolic velocity (S). In a separate external validation cohort (n = 53, simultaneous echocardiography and RHC), ePAWP showed good agreement with invasive PAWP (mean ± standard deviation difference 0.5 ± 5.0 mmHg) and good diagnostic accuracy for estimating PAWP >15 mmHg [area under the curve (95% confidence interval) 0.94 (0.88-1.00)]. Among patients in NEDA [n = 38,856, median (interquartile range) follow-up 4.8 (2.3-8.0) years, 2756 cardiovascular deaths], ePAWP was associated with cardiovascular death even after adjustment for age, sex, and diastolic dysfunction grading [hazard ratio (HR) 1.08 (1.07-1.09) per mmHg] and provided incremental prognostic information to diastolic dysfunction grading (improved C-statistic from 0.65 to 0.68, P < 0.001). Increased ePAWP was associated with worse prognosis across all grades of diastolic function [HR normal, 1.07 (1.06-1.09); indeterminate, 1.08 (1.07-1.09); abnormal, 1.08 (1.07-1.09), P < 0.001 for all]. CONCLUSION Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction grading.
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Affiliation(s)
- Thomas Lindow
- Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Kolling Building, St Leonards, Sydney, New South Wales 2065, Australia
| | - Aristomenis Manouras
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Lindqvist
- Department of Clinical Physiology, Surgical and Perioperative sciences, Umeå University, Umeå, Sweden
| | - Daniel Manna
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Björn Wieslander
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Kolling Building, St Leonards, Sydney, New South Wales 2065, Australia
| | - Geoff Strange
- Institute for Health Research, School of Medicine, University of Notre Dame, Fremantle, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Heart Research Institute, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
| | - David Playford
- Institute for Health Research, School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Kolling Building, St Leonards, Sydney, New South Wales 2065, Australia
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden
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